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Follow-Up After Hospitalization for Mental Illness

Advantage MD, EHP, and USFHP. Members 6 years of age and older.

The percent of discharges for members age 6 and older who were hospitalized for treatment of selected mental illness diagnoses or intentional self-harm diagnoses and who had a follow-up visit with a mental health practitioner.

Two rates are reported:

  • Discharges for which the member received follow-up within 30 days after discharge
  • Discharges for which the member received follow-up within 7 days after discharge

Provider Specialty: Mental Health Practitioner.

Best Practice and Measure Tips

  • Visits that occur on the date of discharge will not count toward compliance.

This measure focuses on follow-up treatment, which must be with a mental health provider.

  • Mental Health Practitioner definition changed to Mental Health Provider and includes certified Community Mental Health Center (CMHC) and certified Physician Assistant.
  • The following visit types do not have to be with a mental health provider to count for numerator compliance:
    • Intensive outpatient encounters, partial hospitalizations, community mental health centers and electroconvulsive therapy settings.
  • Refer patient to a mental health provider to be seen within seven days of discharge.
  • Even patients receiving medication from their primary care provider still need post-discharge supportive therapy with a licensed mental health clinician such as a therapist or social worker.
  • Telehealth visits with a behavioral health provider are acceptable.

Behavioral Health visits count toward compliance.

Measure Exclusions

Required Exclusions: Hospice.

Measure Codes

  • Common Visit Codes:
    • 90791, 90792, 90832-90834, 90836-90840, 90845, 90847, 90849, 90853, 90875, 90876, 99221-99223, 99231-99233, 99238, 99239, 99251–99255
    • POS: 02
  • Observation
    • CPT: 99217-99220
  • Transitional Care Management
    • CPT: 99495, 99496
  • BH Outpatient Visit with Mental Health Practitioner
    • CPT: 98960-98962, 99078, 99201-99205, 99211-99215, 99241-99245, 99341-99345, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99411, 99412, 99510, 99483
    • HCPCS: G0155, G0176, G0177, G0409, G0463, H0002,H0004, H0031, H0034, H0036, H0037, H0039, H0040, H2000, H2010, H2011, H2013, H2014, H2015, H2016, H2017, H2018, H2019, H2020, M0064, T1015