UNHEALTHY ALCOHOL USE SCREENING and FOLLOW-UP (ASF) HEDIS (Administrative)

Transcription

1 UNHEALTHY ALCOHOL USE SCREENING and FOLLOW-UP (ASF) APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included? STANDARD OF CARE NCQA ACCEPTED CODES HEDIS (Administrative) To ensure clinicians screen adults aged 18 years or older for alcohol misuse and provide brief behavioral counseling interventions to those who misuse alcohol. Members age eighteen (18)) years and older as January 1 st of the measurement year. Exclude members with a diagnosis or history of any of the following: Alcohol use disorder Dementia In Hospice or using hospice services To ensure members ages eighteen (18) years and older who were screened for unhealthy alcohol use using a standardized tool and, if screened positive, received appropriate follow-up care. Unhealthy Alcohol Use Screening. The percentage of members who had a systematic screening for unhealthy alcohol use. Counseling or other follow-up. The percentage of members who screened positive for unhealthy alcohol use and received brief counseling or other follow-up care within 2 months of a positive screening. Please see code table. DOCUMENTATION REQUIREMENTS What documentation should be submitted? The medical record should document that member had been assessed for unhealthy alcohol use using an assessment tool that has been normalized and validated for the adult population such as: Alcohol Use Disorders Identification Test (AUDIT) Screening instrument (score 8) Alcohol Use Disorders Identification Test Consumption (AUDIT-C) Screening Instrument (score 4 for men; score 3

2 REFERENCES for women). Single-Question Screening: How many times in the past year have you had 5 (for men) or 4 (for women and all adults older than 65 years) or more drinks in a day? (response 1). Counseling refers to one or more counseling sessions, a minimum of 5-15 minutes, which may include at least one of the following: Feedback on alcohol use and harms Identification of high risk situations for drinking and coping strategies Increase the motivation to reduce drinking Development of a personal plan to reduce drinking Documentation of receiving alcohol misuse treatment For more information, please refer to Passport Health Plan s Substance Use Disorder Clinical Practice Guidelines. Additionally, Beacon has various Provider Toolkits available to providers. The criteria above are based on standards established under NCQA s HEDIS 2018 Technical Specifications. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). BEACON Behavioral health case management is available for Passport members. Our behavioral health case managers work with our medical case managers to coordinate care and communication between providers. To make a referral, call the Behavioral Health Hotline at

3 UNHEALTHY ALCOHOL USE SCREENING AND FOLLOW-UP Meet Screening Criteria Alcohol Counseling and Treatment Code System Code Definition CPT CPT HCPCS G0396 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes (G0396) HCPCS G0397 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes (G0397) HCPCS G0443 Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes (G0443) HCPCS H0005 Alcohol and/or drug services; group counseling by a clinician (H0005) HCPCS H0007 Alcohol and/or drug services; crisis intervention (outpatient) (H0007) HCPCS H0015 Alcohol and/or drug services; intensive outpatient (treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan), including assessment, counseling; crisis intervention, and activity therap HCPCS H0016 Alcohol and/or drug services; medical/somatic (medical intervention in ambulatory setting) (H0016) HCPCS H0022 Alcohol and/or drug intervention service (planned facilitation) (H0022) HCPCS H0050 Alcohol and/or drug services, brief intervention, per 15 minutes (H0050) HCPCS H2035 Alcohol and/or other drug treatment program, per hour (H2035) HCPCS H2036 Alcohol and/or other drug treatment program, per diem (H2036) HCPCS T1006 Alcohol and/or substance abuse services, family/couple counseling (T1006) HCPCS T1012 Alcohol and/or substance abuse services, skills development (T1012) ICD10CM Z71.41 [Z71.41] Alcohol abuse counseling and surveillance of alcoholic ICD10CM Z71.89 [Z71.89] Other specified counseling Alcohol rehabilitation and detoxification (regime/therapy) Combined alcohol and drug rehabilitation and detoxification (regime/therapy) Alcoholism counseling (procedure) Detoxication psychiatric therapy for alcoholism (regime/therapy) Substance use treatment: alcohol withdrawal (regime/therapy) Alcohol abuse prevention (procedure) Alcohol abuse prevention education (procedure)

4 Alcohol abuse prevention management (procedure) Counseling about alcohol consumption (procedure) Alcohol reduction program (regime/therapy) Alcohol brief intervention (procedure) Alcohol Screening Code System Code Definition CPT CPT CPT-CAT-II 3016F PT SCRND UNHLTHY OH USE HCPCS G0396 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and brief intervention 15 to 30 minutes (G0396) HCPCS G0397 Alcohol and/or substance (other than tobacco) abuse structured assessment (e.g., audit, dast), and intervention, greater than 30 minutes (G0397) HCPCS G0442 Annual alcohol misuse screening, 15 minutes (G0442) HCPCS H0001 Alcohol and/or drug assessment (H0001) HCPCS H0049 Alcohol and/or drug screening (H0049) LOINC How many times in the past year have you have X or more drinks in a day [SAMHSA] LOINC How many standard drinks containing alcohol do you have on a typical day [SAMHSA] LOINC How often do you have 6 or more drinks on 1 occasion [SAMHSA] LOINC Alcohol Use Disorder Identification Test - Consumption [AUDIT-C] LOINC Alcohol Use Disorder Identification Test [AUDIT] LOINC Total score [AUDIT] LOINC Total score [AUDIT-C] Alcohol consumption screening (procedure) Alcohol abuse prevention assessment (procedure) Screening for alcohol abuse (procedure) Exclusions Alcohol Use Disorder Code System Code Definition ICD10CM F10.10 [F10.10] Alcohol abuse, uncomplicated ICD10CM F [F10.120] Alcohol abuse with intoxication, uncomplicated ICD10CM F [F10.121] Alcohol abuse with intoxication delirium ICD10CM F [F10.129] Alcohol abuse with intoxication, unspecified ICD10CM F10.14 [F10.14] Alcohol abuse with alcohol-induced mood disorder ICD10CM F [F10.150] Alcohol abuse with alcohol-induced psychotic disorder with delusions

5 ICD10CM F [F10.151] Alcohol abuse with alcohol-induced psychotic disorder with hallucinations ICD10CM F [F10.159] Alcohol abuse with alcohol-induced psychotic disorder, unspecified ICD10CM F [F10.180] Alcohol abuse with alcohol-induced anxiety disorder ICD10CM F [F10.181] Alcohol abuse with alcohol-induced sexual dysfunction ICD10CM F [F10.182] Alcohol abuse with alcohol-induced sleep disorder ICD10CM F [F10.188] Alcohol abuse with other alcohol-induced disorder ICD10CM F10.19 [F10.19] Alcohol abuse with unspecified alcohol-induced disorder ICD10CM F10.20 [F10.20] Alcohol dependence, uncomplicated ICD10CM F [F10.220] Alcohol dependence with intoxication, uncomplicated ICD10CM F [F10.221] Alcohol dependence with intoxication delirium ICD10CM F [F10.229] Alcohol dependence with intoxication, unspecified ICD10CM F [F10.230] Alcohol dependence with withdrawal, uncomplicated ICD10CM F [F10.231] Alcohol dependence with withdrawal delirium ICD10CM F [F10.232] Alcohol dependence with withdrawal with perceptual disturbance ICD10CM F [F10.239] Alcohol dependence with withdrawal, unspecified ICD10CM F10.24 [F10.24] Alcohol dependence with alcohol-induced mood disorder ICD10CM F [F10.250] Alcohol dependence with alcohol-induced psychotic disorder with delusions ICD10CM F [F10.251] Alcohol dependence with alcohol-induced psychotic disorder with hallucinations ICD10CM F [F10.259] Alcohol dependence with alcohol-induced psychotic disorder, unspecified ICD10CM F10.26 [F10.26] Alcohol dependence with alcohol-induced persisting amnestic disorder ICD10CM F10.27 [F10.27] Alcohol dependence with alcohol-induced persisting dementia ICD10CM F [F10.280] Alcohol dependence with alcohol-induced anxiety disorder ICD10CM F [F10.281] Alcohol dependence with alcohol-induced sexual dysfunction ICD10CM F [F10.282] Alcohol dependence with alcohol-induced sleep disorder ICD10CM F [F10.288] Alcohol dependence with other alcohol-induced disorder ICD10CM F10.29 [F10.29] Alcohol dependence with unspecified alcohol-induced disorder ICD10CM F [F10.920] Alcohol use, unspecified with intoxication, uncomplicated ICD10CM F [F10.921] Alcohol use, unspecified with intoxication delirium ICD10CM F [F10.929] Alcohol use, unspecified with intoxication, unspecified ICD10CM F10.94 [F10.94] Alcohol use, unspecified with alcohol-induced mood disorder ICD10CM F [F10.950] Alcohol use, unspecified with alcohol-induced psychotic disorder with delusions ICD10CM F [F10.951] Alcohol use, unspecified with alcohol-induced psychotic disorder with hallucinations ICD10CM F [F10.959] Alcohol use, unspecified with alcohol-induced psychotic disorder, unspecified ICD10CM F10.96 [F10.96] Alcohol use, unspecified with alcohol-induced persisting amnestic disorder ICD10CM F10.97 [F10.97] Alcohol use, unspecified with alcohol-induced persisting dementia ICD10CM F [F10.980] Alcohol use, unspecified with alcohol-induced anxiety disorder

6 ICD10CM F [F10.981] Alcohol use, unspecified with alcohol-induced sexual dysfunction ICD10CM F [F10.982] Alcohol use, unspecified with alcohol-induced sleep disorder ICD10CM F [F10.988] Alcohol use, unspecified with other alcohol-induced disorder ICD10CM F10.99 [F10.99] Alcohol use, unspecified with unspecified alcohol-induced disorder ICD10CM K29.20 [K29.20] Alcoholic gastritis without bleeding ICD10CM K29.21 [K29.21] Alcoholic gastritis with bleeding ICD10CM K70.10 [K70.10] Alcoholic hepatitis without ascites ICD10CM K70.11 [K70.11] Alcoholic hepatitis with ascites Dementia associated with alcoholism (disorder) Alcohol hallucinosis (disorder) Alcoholism (disorder) Alcohol withdrawal delirium (disorder) Alcohol abuse (disorder) Alcohol intoxication delirium (disorder) Alcohol-induced organic mental disorder (disorder) Alcohol-induced anxiety disorder (disorder) Alcohol-induced sleep disorder (disorder) Alcohol-induced psychosis (disorder) Alcohol-induced mood disorder (disorder) Alcohol-induced psychotic disorder with delusions (disorder) Alcohol dependence (disorder) Alcohol amnestic disorder (disorder) Alcohol-induced sexual dysfunction (finding) Alcohol paranoia (disorder) Uncomplicated alcohol withdrawal (disorder) Korsakov's alcoholic psychosis with peripheral neuritis (disorder)

7 Chronic alcoholic brain syndrome (disorder) Alcohol withdrawal hallucinosis (disorder) Pathological alcohol intoxication (disorder) Alcoholic paranoia (disorder) Alcohol withdrawal syndrome (disorder) Acute alcoholic intoxication in alcoholism (disorder) Continuous acute alcoholic intoxication in alcoholism (disorder) Episodic acute alcoholic intoxication in alcoholism (disorder) Acute alcoholic intoxication in remission, in alcoholism (disorder) Continuous chronic alcoholism (disorder) Episodic chronic alcoholism (disorder) Chronic alcoholism in remission (disorder) Nondependent alcohol abuse, continuous (disorder) Nondependent alcohol abuse, episodic (disorder) Nondependent alcohol abuse in remission (disorder) Nondependent alcohol abuse (disorder) Persistent alcohol abuse (disorder) Mild alcohol dependence (disorder) Severe alcohol dependence (disorder) Moderate alcohol dependence (disorder) Thrombocytopenia co-occurrent and due to alcoholism (disorder) Insomnia caused by alcohol (disorder) Alcohol dependence in pregnancy (disorder)

8 Alcohol dependence in childbirth (disorder) Dementia Code System Code Definition ICD10CM F01.50 [F01.50] Vascular dementia without behavioral disturbance ICD10CM F01.51 [F01.51] Vascular dementia with behavioral disturbance ICD10CM F02.80 [F02.80] Dementia in other diseases classified elsewhere without behavioral disturbance ICD10CM F02.81 [F02.81] Dementia in other diseases classified elsewhere with behavioral disturbance ICD10CM F03.90 [F03.90] Unspecified dementia without behavioral disturbance ICD10CM F03.91 [F03.91] Unspecified dementia with behavioral disturbance ICD10CM F04 [F04] Amnestic disorder due to known physiological condition ICD10CM F10.27 [F10.27] Alcohol dependence with alcohol-induced persisting dementia ICD10CM F10.97 [F10.97] Alcohol use, unspecified with alcohol-induced persisting dementia ICD10CM F13.27 [F13.27] Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia ICD10CM F13.97 [F13.97] Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia ICD10CM F18.17 [F18.17] Inhalant abuse with inhalant-induced dementia ICD10CM F18.27 [F18.27] Inhalant dependence with inhalant-induced dementia ICD10CM F18.97 [F18.97] Inhalant use, unspecified with inhalant-induced persisting dementia ICD10CM F19.17 [F19.17] Other psychoactive substance abuse with psychoactive substanceinduced persisting dementia ICD10CM F19.27 [F19.27] Other psychoactive substance dependence with psychoactive substance-induced persisting dementia ICD10CM F19.97 [F19.97] Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia ICD10CM G30.0 [G30.0] Alzheimer's disease with early onset ICD10CM G30.1 [G30.1] Alzheimer's disease with late onset ICD10CM G30.8 [G30.8] Other Alzheimer's disease ICD10CM G30.9 [G30.9] Alzheimer's disease, unspecified ICD10CM G31.83 [G31.83] Dementia with Lewy bodies ICD9CM Senile dementia, uncomplicated ICD9CM Presenile dementia, uncomplicated ICD9CM Presenile dementia with delirium ICD9CM Presenile dementia with delusional features ICD9CM Presenile dementia with depressive features ICD9CM Senile dementia with delusional features ICD9CM Senile dementia with depressive features ICD9CM Senile dementia with delirium ICD9CM Vascular dementia, uncomplicated ICD9CM Vascular dementia, with delirium ICD9CM Vascular dementia, with delusions

9 ICD9CM Vascular dementia, with depressed mood ICD9CM Other specified senile psychotic conditions ICD9CM Unspecified senile psychotic condition ICD9CM Alcohol-induced persisting dementia ICD9CM Drug-induced persisting dementia ICD9CM Amnestic disorder in conditions classified elsewhere ICD9CM Dementia in conditions classified elsewhere without behavioral disturbance ICD9CM Dementia in conditions classified elsewhere with behavioral disturbance ICD9CM Dementia, unspecified, without behavioral disturbance ICD9CM Dementia, unspecified, with behavioral disturbance ICD9CM Alzheimer's disease ICD9CM Dementia with lewy bodies Hospice Code System Code Definition CPT CPT HCPCS G0182 Physician supervision of a patient under a medicare-approved hospice (patient not present) requiring complex and multidisciplinary care modalities involving regular physician development and/or revision of care plans, review of subsequent reports of patie HCPCS G9473 Services performed by chaplain in the hospice setting, each 15 minutes (G9473) HCPCS G9474 Services performed by dietary counselor in the hospice setting, each 15 minutes (G9474) HCPCS G9475 Services performed by other counselor in the hospice setting, each 15 minutes (G9475) HCPCS G9476 Services performed by volunteer in the hospice setting, each 15 minutes (G9476) HCPCS G9477 Services performed by care coordinator in the hospice setting, each 15 minutes (G9477) HCPCS G9478 Services performed by other qualified therapist in the hospice setting, each 15 minutes (G9478) HCPCS G9479 Services performed by qualified pharmacist in the hospice setting, each 15 minutes (G9479) HCPCS Q5003 Hospice care provided in nursing long term care facility (ltc) or non-skilled nursing facility (nf) (Q5003) HCPCS Q5004 Hospice care provided in skilled nursing facility (snf) (Q5004) HCPCS Q5005 Hospice care provided in inpatient hospital (Q5005) HCPCS Q5006 Hospice care provided in inpatient hospice facility (Q5006) HCPCS Q5007 Hospice care provided in long term care facility (Q5007) HCPCS Q5008 Hospice care provided in inpatient psychiatric facility (Q5008) HCPCS Q5010 Hospice home care provided in a hospice facility (Q5010) HCPCS S9126 Hospice care, in the home, per diem (S9126) HCPCS T2042 Hospice routine home care; per diem (T2042) HCPCS T2043 Hospice continuous home care; per hour (T2043) HCPCS T2044 Hospice inpatient respite care; per diem (T2044)

10 HCPCS T2045 Hospice general inpatient care; per diem (T2045) HCPCS T2046 Hospice long term care, room and board only; per diem (T2046) UBREV 0115 UBREV 0125 UBREV 0135 UBREV 0145 UBREV 0155 UBREV 0235 UBREV 0650 UBREV 0651 UBREV 0652 UBREV 0655 UBREV 0656 UBREV 0657 UBREV 0658 UBREV A 081B 081C 081D 081E 081F 081G 081H

11 081I 081J 081K 081M 081O 081X 081Y 081Z 082A 082B 082C 082D 082E 082F 082G 082H 082I 082J 082K 082M 082O 082X 082Y 082Z