eCQM: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (CMS137v5)

Note: Access to the EHR features described in this article may differ for practices who have already purchased a Practice Fusion EHR subscription plan. Please contact Practice Fusion Customer Service for additional information.  

eMeasure ID:

CMS 137v5

Measure Type:

Process

MIPS High Priority Measure:

No

Quality ID:

305

Eligible for Quality Programs:

  • Merit-Based Incentive Payment System (MIPS)
  • Medicaid EHR Incentive Program (Meaningful Use)
  • Comprehensive Primary Care Plus (CPC+)

Performance Benchmark for MIPS:

This measure does not have an assigned benchmark for the 2017 performance year. Quality measures without historical benchmarks will be assigned benchmarks based on data reported to CMS.

Description:

Percentage of patients 13 years of age and older with a new episode of alcohol and other drug (AOD) dependence who received the following. Two rates are reported:

  1. Percentage of patients who initiated treatment within 14 days of the diagnosis.
  2. Percentage of patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit.

  • Numerator 1: Patients who initiated treatment within 14 days of the diagnosis.

  • Numerator 2: Patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit.

  • Denominator: Patients age 13 years of age and older who were diagnosed with a new episode of alcohol or drug dependency during a visit in the first 11 months of the measurement period (see examples of eligible visits in Table 1).

    • Denominator Exclusions: Patients with a previous active diagnosis of alcohol or drug dependence in the 60 days prior to the first episode of alcohol or drug dependence.

    • Exclude patients who were in hospice care during the measurement year.

    • Denominator Exceptions: None

eCQM Patient Reports

eCQM Patient Reports can help you identify patient care gaps and improve the performance of your quality measures. Click on the blue result numbers in the eCQM Dashboard to see the patient report for this measure.

The eCQM Patient Reports list the individual patients included in the measure’s population, which measure cohorts the patient is in, and contact information for the patient to streamline any downstream communication that may be needed to fulfill the measure requirements. You can choose to print the patient list for a measure or export it as a CSV.

The measure cohorts included in the eCQM Patient Report for CMS 137v5 Initiation and Engagement of Alcohol and Other Drug Dependence Treatment are:

  • Initial patient population
  • Denominator
  • Numerator
  • Exclusion

Practice Fusion Suggested Workflow

Practice Fusion suggests the following workflow to help ensure that you are able to meet the requirements of this measure within the Practice Fusion EHR.

  1. The denominator of this measure will include patients age 13 years and older with a new diagnosis of alcohol or drug dependence and a denominator-eligible encounter during the first 10 months of the measurement period.

    1. Denominator-eligible encounters are signed SOAP notes with a Date of Service during the first 10 months of the measurement period and an encounter type from one of the following value sets: Face-to-Face Interaction or Detoxification Visit (see Table 1 for example encounter types from these value sets)

    2. The new diagnosis must come from the Alcohol and Drug Dependence (AOD) value set and have a start date that is the same as the encounter described above (see Table 1 for example diagnosis codes from this value set)

  2. For Numerator 1, record that an encounter for Alcohol and Drug Dependence Treatment was performed within 14 days of the denominator-eligible encounter in which the new diagnosis of AOD was recorded (see Step 1 above).

    1. See Table 2 for examples of numerator-eligible Alcohol and Drug Dependence Treatment encounter types.

    2. Click here to learn how to configure encounter types in Practice Fusion.

  3. For Numerator 2, record an encounter to indicate that a second Alcohol and Drug Dependence Treatment was performed within 30 days of the denominator-eligible encounter in which the new diagnosis of AOD was recorded in Step 1 above.

    1. See Table 2 for examples of numerator-eligible Alcohol and Drug Dependence Treatment encounter types.

    2. Click here to learn how to configure encounter types in Practice Fusion.

Note: If a patient is seen for a numerator-eligible encounter within 14 days of the denominator-eligible encounter and again within 15-30 days of the denominator-eligible encounter, the patient will qualify for both Numerator 1 and Numerator 2.

Table 1. Documentation Examples for CMS 137v5

Value Set Name & Type

Example Data Elements to Record

Face to Face Interaction

Encounter

  • Office visit (SNOMED 185349003)
  • Nurse visit (SNOMED 19681004)
  • Nursing home visit (SNOMED 207195004)
  • Home visit (SNOMED 439708006)
  • Patient-initiated encounter (SNOMED 270427003)

Detoxification Visit

Encounter

  • Drug addiction therapy (SNOMED 266707007)
  • Alcohol rehabilitation and detoxification (SNOMED 20093000)
  • Drug rehabilitation and detoxification (SNOMED 56876005)

Alcohol and Drug Dependence

Diagnosis

  • Alcohol abuse, uncomplicated (ICD-10 F10.10)
  • Opioid abuse, uncomplicated (ICD-10 F11.10)
  • Other psychoactive substance dependence with withdrawal delirium (ICD-10 F19.231)
  • Other stimulant use, unspecified with stimulant-induced mood disorder (ICD-10 F15.94)
  • Inhalant Use, Uncomplicated (ICD-10 F18.10)

Alcohol and Drug Dependence Treatment

Encounter

  • Drugs of addiction education (procedure) (SNOMED 171047005)
  • Prevention of opioid abuse (procedure) (SNOMED 426928008)
  • Counseling about alcohol consumption (procedure) (SNOMED 413473000)


CMS 137v5 Denominator Exclusion Requirements

To be recognized for the denominator exclusion, the patient must have a previous active diagnosis of alcohol and drug dependence recorded in his/her chart in the 60 days prior to the new episode of alcohol or drug dependence.

  • Diagnosis must have a valid start date and no stop date.

  • Examples of alcohol and drug dependence diagnoses include:

    • Alcohol abuse with intoxication, uncomplicated (ICD-10 F10.12)

    • Inhalant abuse with inhalant-induced mood disorder (ICD-10 F18.14)

    • Opioid dependence with other opioid-induced disorder (ICD-10 F11.288)  

More Information

eCQMs

  1. How does the eCQM Dashboard work?
  2. How​ ​do​ ​I​ ​create​ ​a​ ​group​ ​in​ ​the​ ​eCQM​ ​Dashboard?
  3. eCQM Depression Remission at Twelve Months (CMS159v5)
  4. eCQM: Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (CMS137v5)
  5. eCQM: Preventive Care and Screening: Screening for Depression and Follow-Up Plan (CMS 2v6)
  6. eCQM: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (CMS 22v5)
  7. eCQM: Closing the Referral Loop: Receipt of Specialist Report (CMS 50v5)
  8. eCQM: Documentation of Current Medications in the Medical Record (CMS 68v6)
  9. eCQM: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up Plan (CMS 69v5)
  10. eCQM: Functional Status Assessments for Congestive Heart Failure (CMS 90v6)
  11. eCQM: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%) (CMS 122v5)
  12. eCQM: Diabetes: Foot Exam (CMS 123v5)
  13. eCQM: Cervical Cancer Screening (CMS 124v5)
  14. eCQM: Breast Cancer Screening (CMS 125v5)
  15. eCQM: Pneumococcal Vaccination Status for Older Adults (CMS 127v5)
  16. eCQM: Colorectal Cancer Screening (CMS 130v5)
  17. eCQM: Diabetes: Eye Exam (CMS 131v5)
  18. eCQM: Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention (CMS 138v5)
  19. eCQM: Falls: Screening for Future Fall Risk (CMS 139v5)
  20. eCQM: Preventive Care and Screening: Influenza Immunization (CMS 147v6)
  21. eCQM: Dementia: Cognitive Assessment (CMS 149v5)
  22. eCQM: Chlamydia Screening for Women (CMS 153v5)
  23. eCQM: Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (CMS 155v5)
  24. eCQM: Use of High-Risk Medications in the Elderly (CMS 156v5)
  25. eCQM: Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antiplatelet (CMS 164v5)
  26. eCQM: Controlling High Blood Pressure (CMS 165v5)
  27. eCQM: Use of Imaging Studies for Low Back Pain (CMS 166v6)

Feedback and Knowledge Base