Product Lines:
EHP, Priority Partners, and USFHP.

Measurement Period: January 1 - December 31

Description:
The percentage of deliveries in which persons were screened for clinical depression while pregnant and, if screened positive, received follow-up care.

• Depression Screening. The percentage of deliveries in which persons were screened for clinical depression during pregnancy using a standardized instrument.
• Follow-Up on Positive Screen. The percentage of deliveries in which persons received follow-up care within 30 days of a positive depression screen finding.

Stratifications: 
Report stratification by race and ethnicity.

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• ECDS. 

Initial Population:

• Measure Item Count: Episode.
• Age: None.
• Benefits: Medical.
• Continuous Enrollment: 28 days prior to the delivery date through the delivery date. 
• Allowable Gap: None.

Denominator:
Deliveries.
Deliveries, in any setting, during the measurement period that have a gestational age assessment or gestational age diagnosis within 1 day of the start or end of the delivery.

Note: The measure is based on deliveries; therefore, it is possible for denominator to include multiple deliveries for the same person. Only the first eligible delivery in a 180-day period is included. 

Numerator:

Numerator 1: Depression Screening
Deliveries in which persons had a documented result for depression screening, using an age-appropriate standardized screening instrument, performed during pregnancy.

• Deliveries between January 1 and December 1 of the measurement period: Screening should be performed between the pregnancy start date and the delivery date (including on the delivery date).
• Deliveries between December 2 and December 31 of the measurement period: Screening should be performed between the pregnancy start date and December 1 of the measurement period.

Numerator 2: Follow-Up on Positive Screen
Deliveries in which persons received follow-up care on or up to 30 days after the date of the first positive screen (31 total days). Any of the following on or up to 30 days after the first positive screen:

• An outpatient, telephone, e-visit or virtual check-in follow-up visit with a diagnosis of depression or other behavioral health conditions.
• A depression case management encounter that documents assessment for symptoms of depression or a diagnosis of depression or other behavioral health condition.
• A behavioral health encounter, including assessment, therapy, collaborative care or medication management.
• A diagnosis of encounter for exercise counseling
• A dispensed antidepressant medication

OR

• Documentation of additional depression screening on a full-length instrument indicating either no depression or no symptoms that require follow-up (i.e., a negative screen) on the same day as a positive screen on a brief screening instrument.

Note: For example, if there is a positive screen resulting from a PHQ-2 score, documentation of a negative finding from a PHQ-9 performed on the same day qualifies as evidence of follow-up.

Depression Screening Instrument (Direct Reference Codes)

A standard assessment instrument that has been normalized and validated for the appropriate patient population. Eligible screening instruments with thresholds for positive findings include:

¹Brief screening instrument. All other instruments are full-length.
²Proprietary; may be cost or licensing requirement associated with use.

 

¹Brief screening instrument. All other instruments are full-length.
²Proprietary; may be cost or licensing requirement associated with use.

Best Practice and Measure Tips

• NCQA Clinical recommendation statement/ rationale: 
  • The U.S. Preventive Services Task Force (USPSTF) recommends screening for depression among adolescents and adults, including pregnant and postpartum women. (B recommendation)⁵
  • The American College of Obstetricians and Gynecologists (ACOG) recommends that clinicians screen patients at the initial prenatal visit, later in pregnancy, and at postpartum visits using a standardized, validated tool.⁶
  • The USPSTF and ACOG also recommend that screening be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment and appropriate follow-up. (B recommendation)⁷
• Make sure to use the appropriate Gestational age diagnosis code Z3A.XX on the claim.
• Only delivery with gestation age 37 weeks or greater will be in the numerator.
• This measure requires the use of an age-appropriate screening instrument. The member’s age is used to select the appropriate depression screening instrument. If the correct age screening is not used, the member will not be compliant.
• Once the member is compliant for the screening, they will remain compliant for the screening element. For the intervention, the system is looking for the first positive screen date.  Intervention compliance status is based on whether there is an intervention for the positive screening date.  Only an earlier date of service with a different compliance can impact the compliance status for the follow-up.
• Documentation in a visit note must include the screening tool name, score, and date performed.  
• The score should be clearly documented on the actual screening tool.  The health plan cannot calculate the score.  
• Depression screening captured in health risk assessments or other types of health assessments are allowed if the questions align with a specific instrument that is validated for depression screening. For example, if a health risk assessment includes questions from the PHQ-2, it counts as screening if the member answered the questions, and a total score is calculated.
• Make it a standard to screen for depression in the history intake nurse visit or at your initial prenatal exam. Continue to screen members throughout the pregnancy and again during the Postpartum timeframe.
• Schedule a follow-up appointment within 30 days after any positive assessments.
• Coordinate care with a behavioral health provider.
• Provide local community support resources and what to do in an event of a crisis.
• Document all treatment options discussed during the visit in the patient’s chart. When clinically appropriate, provide exercise counseling in addition to prescribing medication, and include diagnosis code Z71.82 to accurately capture this service. Comprehensive documentation supports accurate reporting and helps ensure the member meets compliance standards.
• Assess the need for Case Management and refer if necessary.
  • The Johns Hopkins Health Plans Care Management team offers a variety of services to help members who are living with substance abuse and mental health issues may receive confidential care management support and coordination of care from a Licensed Clinical Social Worker. These behavioral health clinicians help members navigate their treatment needs for conditions such as depression, anxiety disorders, addictions, and autism spectrum disorders. For Priority Partners members, we work with Carelon Behavioral Health of Maryland to manage mental health needs.
    • Please send us your member referrals by contacting us at:
      Phone: 800-557-6916
      Monday through Friday: 8 a.m. to 5 p.m.
      Voicemail messages received after normal business hours will be addressed the following business day.
      EHP Behavioral Health: 410-424-4891
      EHP Behavioral Health- Secured: 410-424-4765
      USFHP Mental Health: 410-424-4839
      Advantage MD Behavioral Health, Inpatient & Outpatient: 844-340-2217
      Email: [email protected]

⁵American College of Obstetricians and Gynecologists. 2023. “Screening and Diagnosis of Mental Health Conditions During Pregnancy and Postpartum: ACOG Clinical Practice Guideline No. 4.” Obstet Gynecol 141.6: 1232–61.
⁶U.S. Preventive Services Task Force et al. 2023. “Screening for Depression and Suicide Risk in Adults: U.S. Preventive Task Force Recommendation Statement.” JAMA vol. 329,23: 2057–67.
⁷U.S. Preventive Services Task Force et al. 2022. “Screening for Depression and Suicide Risk in Children and Adolescents: U.S. Preventive Task Force Recommendation Statement.” JAMA vol. 328,15: 1534–42.

Measure Exclusions

Denominator Exclusions:

• Deliveries that occurred at less than 37 weeks gestation.
• Deliveries in which persons were in hospice or using hospice services any time during the measurement period.
• Persons who die any time during the measurement period.

Exclusion Codes

Weeks of Gestation Less Than 37 at the time of delivery:

• ICD-10-CM: Z3A.01, Z3A.08, Z3A.09, Z3A.10, Z3A.11, Z3A.12, Z3A.13, Z3A.14, Z3A.15, Z3A.16, Z3A.17, Z3A.18, Z3A.19, Z3A.20, Z3A.21, Z3A.22, Z3A.23, Z3A.24, Z3A.25, Z3A.26, Z3A.27, Z3A.28, Z3A.29, Z3A.30, Z3A.31, Z3A.32, Z3A.33, Z3A.34, Z3A.35, Z3A.36

Measure Codes

Follow-up on Positive Screening

An outpatient, telephone, e-visit or virtual check-in follow-up visit

• CPT: 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 98960, 98961, 98962, 98966, 98967, 98968, 98970, 98971, 98972, 98980, 98981, 99078, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99242, 99243, 99244, 99245, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99421, 99422, 99423, 99441, 99442, 99443, 99457, 99458, 99483
• HCPCS: G0071, G0463, G2010, G2012, G2250, G2251, G2252, T1015**
  NOTE: **T1015 HCPCS code which identifies an all-inclusive clinic visit for services rendered at a Federally Qualified Health Center (FQHC)
• SNOMED CT US Edition: 42137004, 50357006, 86013001, 90526000, 108220007, 108221006, 185317003, 185389009, 281036007, 314849005, 386472008, 386473003, 390906007, 401267002, 406547006, 870191006
• UBREV: 0510, 0513, 0516, 0517, 0519, 0520, 0521, 0522, 0523, 0526, 0527, 0528, 0529, 0982, 0983

A depression case management encounter

• CPT: 99366, 99492, 99493, 99494
• HCPCS: G0512, T1016, T1017, T2022, T2023
• SNOMED CT US Edition: 182832007, 225333008, 385828006, 386230005, 409022004, 410216003, 410219005, 410328009, 410335001, 410346003, 410347007, 410351009, 410352002, 410353007, 410354001, 410356004, 410360001, 410363004, 410364005, 410366007, 416341003, 416584001, 424490002, 425604002, 737850002, 1344983001, 1344984007, 1344994002, 1345003009, 1345013001, 1345014007, 621561000124106, 661051000124109, 662081000124106, 662541000124107, 842901000000108

Symptoms of Depression

• SNOMED CT: 394924000, 788976000

Depression or Other Behavioral Health Condition

• ICD-10-CM: F01.511, F01.518, F06.4, F10.180, F10.280, F10.980, F11.188, F11.288, F11.988, F12.180, F12.280, F12.980, F13.180, F13.280, F13.980, F14.180, F14.280, F14.980, F15.180, F15.280, F15.980, F16.180, F16.280, F16.980, F18.180, F18.280, F18.980, F19.180, F19.280, F19.980, F20.0, F20.1, F20.2, F20.3, F20.5, F20.81, F20.89, F20.9, F21, F22, F23, F24, F25.0, F25.1, F25.8, F25.9, F28, F29, F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.8, F30.9, F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30, F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62, F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74, F31.75, F31.76, F31.77, F31.78, F31.81, F31.89, F31.9, F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.81, F32.89, F32.9, F32.A, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.8, F33.9, F34.0, F34.1, F34.81, F34.89, F34.9, F39, F40.00, F40.01, F40.02, F40.10, F40.11, F40.210, F40.218, F40.220, F40.228, F40.230, F40.231, F40.232, F40.233, F40.240, F40.241, F40.242, F40.243, F40.248, F40.290, F40.291, F40.298, F40.8, F40.9, F41.0, F41.1, F41.3, F41.8, F41.9, F42.2, F42.3, F42.4, F42.8, F42.9, F43.0, F43.10, F43.11, F43.12, F43.20, F43.21, F43.22, F43.23, F43.24, F43.25, F43.29, F43.81, F43.89, F43.9, F44.89, F45.21, F51.5, F53.0, F53.1, F60.0, F60.1, F60.2, F60.3, F60.4, F60.5, F60.6, F60.7, F60.81, F60.89, F60.9, F63.0, F63.1, F63.2, F63.3, F63.81, F63.89, F63.9, F68.10, F68.11, F68.12, F68.13, F68.8, F68.A, F84.0, F84.2, F84.3, F84.5, F84.8, F84.9, F90.0, F90.1, F90.2, F90.8, F90.9, F91.0, F91.1, F91.2, F91.3, F91.8, F91.9, F93.0, F93.8, F93.9, F94.0, F94.1, F94.2, F94.8, F94.9, O90.6, O99.340, O99.341, O99.342, O99.343, O99.344, O99.345
• SNOMED CT US Edition: 109006, 162004, 281004, 600009, 832007, 899001, 1145003, 1196001, 1376001, 1380006, 1383008, 1499003, 1686006, 1816003, 1855002, 1973000, 2312009, 2403008, 2506003, 2618002, 2815001*
  *Please note that not all SNOMED CT US Edition codes are listed here. For access to the complete set of codes related to PND-E measure, contact your Provider Engagement Liaison or email [email protected].

A behavioral health encounter, including assessment, therapy, collaborative care or medication management

• CPT: 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90839, 90845, 90846, 90847, 90849, 90853, 90865, 90867, 90868, 90869, 90870, 90875, 90876, 90880, 90887, 99484, 99492, 99493
• HCPCS: G0155, G0176, G0177, G0409, G0410, G0411, G0511, G0512, H0002, H0004, H0031, H0034, H0035, H0036, H0037, H0039, H0040, H2000, H2001, H2010, H2011, H2012, H2013, H2014, H2015, H2016, H2017, H2018, H2019, H2020, S0201, S9480, S9484, S9485
• SNOMED CT US Edition: 5694008, 10197000, 10997001, 38756009, 45392008, 79094001, 88848003, 90407005, 91310009, 165171009, 165190001, 225337009, 370803007, 372067001, 385721005, 385724002, 385725001, 385726000, 385727009, 385887004, 385889001, 385890005, 401277000, 410223002, 410224008, 410225009, 410226005, 410227001, 410228006, 410229003, 410230008, 410231007, 410232000, 410233005, 410234004, 439141002
• UBREV: 0900, 0901, 0902, 0903, 0904, 0905, 0907, 0911, 0912, 0913, 0914, 0915, 0916, 0917, 0919

A diagnosis of encounter for exercise counseling

• ICD-10-CM code Z71.82

Measure Medication

Antidepressant Medications

• Amitriptyline
• Amitriptyline-chlordiazepoxide
• Amitriptyline-perphenazine
• Amoxapine
• Bupropion
• Citalopram
• Clomipramine
• Desipramine
• Desvenlafaxine
• Doxepin
• Duloxetine
• Escitalopram
• Fluoxetine
• Fluoxetine-olanzapine
• Fluvoxamine
• Imipramine
• Imipramine pamoate
• Isocarboxazid
• Levomilnacipran
• Maprotiline
• Mirtazapine
• Nefazodone
• Nortriptyline
• Paroxetine
• Paroxetine mesylate
• Phenelzine
• Protriptyline
• Selegiline
• Sertraline
• Tranylcypromine
• Trazodone
• Trimipramine
• Venlafaxine
• Vilazodone
• Vortioxetine