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 Depression Measures‐Summary of Redesign Recommendations Scope of Work For background, please refer to the Depression SBAR document from the April 2016 MARC meeting. At this meeting, MARC approved the convening of a multi‐stakeholder workgroup for three specific topics to be considered: 1. Consider the inclusion of adolescents (age 12 to 17) • If yes; consider several measure options • If yes, consider 4 to 8 month (or +/‐ 60 days) follow‐up window 2. Consideration of PRO tools in addition to PHQ‐9 • Due diligence; needs to fit current measure construct • If adolescents included; additional considerations 3. Review appropriateness of current exclusion criteria • Death, nursing home, hospice or palliative care, bipolar and personality disorder • If adolescents included; review NCQA suggestions A measure development workgroup was convened this summer to review, discuss and make recommendations for revisions to the current set of depression measures. Work was concluded after 3 two‐hour meetings in July and August, each meeting focusing on one topic. This workgroup, chaired by Michael Trangle, MD psychiatrist at HealthPartners Medical Group, had well balanced representation from primary care, pediatrics, adult and adolescent psychiatry (see roster last page). The workgroup was engaged, collaborative and remained patient centered in their focus. Goal Includes Alignment NCQA has adapted some our depression measures for HEDIS (Healthcare Effectiveness Data and Information Set) health plan accreditation program. Draft specifications for the HEDIS adaptation of the depression measures are aligned in many ways (measure construct, follow‐up assessment window, use of the PHQ‐9), but also include some key differences (includes ages 12 and older, exclusions for psychotic and developmental disorders) which are the basis for some of the development workgroup’s scope of work. NCQA and MNCM agree that it would be better to have one aligned measure rather than duplicative or one‐off measures by different stewards. Task 1: Including Adolescents in Measures of Depression Outcomes The first workgroup meeting was devoted to the discussion of incorporating adolescents into measures of depression outcomes. All agreed that depression is a concern for the adolescent population and this is supported by prevalence statistics.  In 2014, an estimated 2.8 million adolescents age 12 to 17 in the United States had at least one major depressive episode in the past year. This represented 11.4% of the U.S. population.1  2013 Youth Risk Behavior Survey of students grades 9 to 12 indicated that during the past 12 months 39.1% (F) and 20.8% (M) indicated feeling sad or hopeless almost every day for at least 2 weeks, planned suicide attempt 16.9% (F) and 10.3% (M) with attempted suicide 10.6% (F) and 5.4% (M)2  Many mental health conditions (anxiety, bipolar, depression, eating disorders, and substance abuse) are evident by age 14.3  In 2015, 9.7% of adolescents in MN who were screened for depression or other mental health conditions, screened positively.4 Discussion relevant to the consideration measuring depression outcomes for adolescents included:  potential life‐long impact affected by adolescent depression (school, work) Page | 1 
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balance between potential stigma of diagnosis versus identifying and treating when functionally impacted level of comfort of primary care providers treating depression in adolescents challenges in screening, diagnosis and treatment of adolescents (adjustment disorder vs. depression) systems in place for treatment, other areas of resources include schools and psychiatric assistance support After thoughtful discussion, the workgroup reached consensus that it was important to include adolescents in the measurement of depression outcomes, but needed to consider all other tasks before determining the best measure construct. Follow‐up Window for Assessment During NCQA’s work on adapting the measure to include adolescents, it was proposed that an increased window for follow‐up was needed, in part due to the challenges in following up with adolescent patients. Workgroup members considered this, but felt that adult patients with depression presented an equal challenge for follow‐up. After subsequent time and analysis of medical groups data with the +/‐ 30 day follow up window, workgroup members feel that an increased assessment window of +/‐ 60 days would be prudent for all patients. Reasons to not expand less than 4 months  Acute treatment phase typically is 6 to 12 weeks but should last until remission  If on medication, should continue at least 6 to 12 months after response  Continuation phase is 4 to 9 months after acute treatment phase  Relapse is common in the first six months; 20 to 85%  Full remission is defined as a two month period without depressive symptoms MNCM staff analyzed the impact of expanding the window for 10 medical groups representing approximately 54,000 patients. Although the net impact of the change on the six month remission outcome rates was 5% (with 95% of the Page | 2 patients unchanged), the workgroup felt that it was reasonable to recommend this technical change and hopes that it will increase provider buy‐in. Once the window is increased, it seems likely that the impact on performance may be much greater than this recalculation, since a wider window will make it possible and desirable for clinics to obtain follow up PHQ9 scores from patients that couldn’t be obtained within the more limited window. The workgroup reached consensus on increasing the follow‐up assessment window to +/‐ 60 days for all patients and all outcome measures. Task 2: Consideration of Additional Patient Reported Outcome Tools As measure stewards, we are frequently asked “Why just the PHQ‐9? Why can’t we use the ___________ tool?” Tools other than the PHQ‐9 have been recommended. If any other tool was to be considered it would need to meet several criteria including strong psychometric properties, empirically defined cut points for remission and depression symptom severity, have a basis in DSM criteria for depression, validation studies supporting the use of the tool to monitor progress and outcomes and be feasible to implement in a clinical setting. List of Tools for Review Beck Depression Inventory (BDI) Beck Depression Inventory‐II (BDI‐II) Beck Depression Inventory‐Primary Care Version (BDI‐PC) Center for Epidemiologic Studies Depression Scale (CES‐D) Child Depression Inventory (CDI) Child Depression Inventory II (CDI‐2) Clinically Useful Depression Outcomes Scale (CUDOS) Columbia Depression Scale Cornell Scale Screening (cognitive impair; admin caregiver) Depression Scale (DEPS) Duke Anxiety‐Depression Scale (DADS) Geriatric Depression Scale Depression Scale (GDS) Mood Feeling Questionnaire OQ 45.2 Patient Health Questionnaire for Adolescents (PHQ‐M)5 Pediatric Symptom Checklist PSC‐17 parent version Pediatric Symptom Checklist PSC‐35 parent version Pediatric Symptom Checklist PSC‐YSR 35 Youth Self Report PROMIS Depression (short form 8b) Quick Inventory of Depression Symptomatology (QIDS) Quick Inventory of Depression Symptomatology (QIDS‐17) CMS Screen 
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Other Peds Workgroup Peds Workgroup Workgroup MNCM public comment Peds Workgroup Peds Workgroup Peds Workgroup Developer Workgroup Page | 3 Template for Review included the following items: Tool Name ▪ Tool Acronym ▪ Developer ▪ Recommended by ▪ Depression Focus or Clear Depression Subscale? ▪ Patient Reported ▪ Remission Cut‐point ▪ Depression Severity Levels ▪ Psychometrics ▪ DSM Criteria ▪ # Items ▪ Summary Score ▪ Age ▪ Scoring ▪ Cost/ Availability ▪ Modes of Administration ▪ Multiple Languages. Information was collected using standardized criteria and complied for the workgroup’s review. With the decision to include adolescents, the group discussed the pros and cons of the age validation studies for the PHQ‐9 tool. PHQ‐9 validity studies support age 13 and older, which is inconsistent with recommended screening starting at age 12. A PHQ‐9M (modified for adolescents) was developed for ages 11 to 17, and although widely used and endorsed by several societies, this very slight modification of the PHQ‐9M has never been formally studied/validated. There is no perfect solution. Research experts on the workgroup question the whole concept of not administering the PHQ‐9 to 12 year olds as studies in ages 13 through 17 did not explore individual ages and ages around the fringe. The workgroup decided to allow both tools, not restrict tool use by age and leave the decision up to the medical groups in terms of which tool best fits their practice (e.g. a pediatric practice could use the PHQ‐9M for all their patients including “older” patients and a family practice clinic could use the PHQ‐9 for all their patients ages 12 and older). Many of the tools listed, especially the tools selected for the CMS screening measure, work well for screening for potential issues with depression, but do not support the diagnosis of depression or measuring outcomes. Many tools did not have the required cut‐points for remission nor scoring levels that address severity of depression symptoms. 6 After the workgroup’s first review and discussion, dismissing those without reliable cut‐points for remission, the remaining tools7 were included in a second round of evaluation. Of the remaining tools for consideration, after taking into account widespread use of the tool and feasibility of implementation in clinical practice, the Beck Depression Inventory (BDI‐II) was discussed at length. Levels of Depression Severity/ Symptoms Tool Total Score Denominator None or Minimal Mild Moderate Moderately Severe Severe Remission PHQ‐9 PHQ‐9M BDI‐II BDI‐FS 27 27 63 21 Score > 9 Score > 9 Score > 19 Score > 8 0 to 4 0 to 4 0 to 13 0 to 3 5 to 9
5 to 9
14 to 19
4 to 8
10 to 14
10 to 14
20 to 28
9 to 12
15 to 19
15 to 19
no equiv
no equiv
20 to 27 20 to 27 29 to 63 13 to 21 < 5
< 5
< 14
< 4
The workgroup had reservations on the impact of measure comparability between practices when different tools are used. This is of particular concern for the response measures (greater than or equal to 50% improved) with a tool that has twice as many questions as well as inclusion in the denominator. Ultimately, the workgroup reached consensus for no additional tools beyond the PHQ‐9 and PHQ‐9M used in the construct of these measures. Task 3: Review of Exclusions Depression, like many chronic or episodic conditions, does not often exist in isolation of other medical conditions. The goals related to measure development in terms of exclusions are to be patient centered and as inclusive as possible without distortion of the measure results. National Quality Forum (NQF) guidance around the use of exclusions is stated in criteria 2b3. Page | 4 2b3. Exclusions are supported by the clinical evidence; otherwise, they are supported by evidence of sufficient frequency of occurrence so that results are distorted without the exclusion.  Examples of evidence that an exclusion distorts measure results include, but are not limited to: frequency of occurrence, variability of exclusions across providers, and sensitivity analyses with and without the exclusion.  Patient preference is not a clinical exception to eligibility and can be influenced by provider interventions.  Risk factors that influence outcomes should not be specified as exclusions. Exclusion Set #1  Death (end of life issues or suicide)  Permanent Nursing Home Resident  Hospice/ Palliative Care Services (end of life issues) Currently part of measure specifications, these are allowable exclusions if they occur any time during the measurement period. Allowable exclusions may or may not be taken by the medical group. After thoroughly discussing the potential impacts of removing any of these lower volume exclusions to the measure, the workgroup decided to retain these allowable exclusions. Exclusion Set #2 Bipolar Disorder A disorder associated with episodes of mood swings ranging from depressive lows to manic highs is an appropriate clinical exclusion from depression outcome measures. The workgroup confirms this exclusion is appropriate and will be retained (without change) as a required exclusion. Exclusion Set #3 Personality Disorder MNCM had received feedback from NQF’s Behavioral Health Standing Committee about the exclusion of personality disorders. The NQF committee felt that an exclusion for these conditions was not relevant for measures of depression outcomes. In its review of current and proposed exclusions, the workgroup wanted to assure that exclusions remain focused on mental health conditions in which the patient could not reliably respond to a self‐assessment due to emotional lability (cluster B) of the concomitant condition (e.g. cyclothymic, borderline, histrionic, and factitious disorders). The personality exclusion value set was all inclusive of the personality disorder section of the coding book, many of which were conditions where the patient could reliably answer a PHQ‐9 (e.g. anti‐social, obsessive compulsive and narcissistic disorders). Several conditions were removed from the exclusion value set. Refer to draft measure specifications for details. The workgroup also decided to change this exclusion types from one that is required to an exclusion that is allowable. Diagnosed personality disorders (versus personality traits) are rare and personality disorders are not included in the mental health conditions that commonly occur with depression.8 Exclusion Set #4 Pervasive Developmental Disorders The pervasive developmental disorder value set proposed as an exclusion by NCQA includes autistic disorder and childhood disintegrative disorder. Workgroup members shared their experiences with adolescent patients who have autism spectrum disorder who are experiencing depression yet answer all the questions as “0” ‐ no symptoms. Autism is typically diagnosed at a much younger age and the clinicians know them fairly well by adolescence, clinicians can note differences that indicate depression symptoms. Due to the potential unreliability in completing the PHQ‐9 accurately and the potential differences in therapy (increased socialization to improve depression symptoms), the workgroup would like to incorporate this as an allowable exclusion. Page | 5 There are several types of conditions and patients who cannot complete a PHQ‐9. Attempts to define them all would be incomplete and would significantly add burden to the measure. The guidance that we have given to practices in the past is that if it is clinically inappropriate to administer a PHQ‐9 to a patient, don’t administer the tool. The patient does not come into the denominator without a PHQ‐9 score. One of the easiest ways to “game” this measure is to never give the PHQ‐9, however we do have a paired process measure to monitor this process. Exclusion Set # 5 Schizophrenia or Psychotic Disorder NCQA’s measure development workgroup asked that this exclusion be considered. The workgroup reviewed and discussed the impact of adding this exclusion, deciding that it makes sense to exclude these patients from the depression measures. The most common mental health diagnoses that can occur with depression are anxiety disorders (GAD, panic, social, phobias, OCD, PTSD), eating disorders (anorexia, bulimia), substance abuse and schizophrenia. Most patients with schizophrenia are treated in a psychiatry setting, and this diagnosis was one of the reasons for the technical specification that requires the depression diagnosis to be in the primary position in the psychiatry setting. The original intent of this criteria was to exclude patients with more serious psychiatric conditions with a secondary diagnosis of depression. With the addition of schizophrenia or psychotic disorder as a value set for exclusion, there really are no other commonly concomitant mental health conditions that require this continued distinction between settings. Workgroup members share that the positionality of the diagnosis is irrelevant in their systems, even in the behavioral health setting. The workgroup is in agreement (consensus) that this technical caveat can be removed. Summary of Conditions for Inclusion and Exclusion from the Measures Included:  Major Depressive Disorder  Dysthymia Required Exclusions:  Bipolar Disorder  Schizophrenia or Psychotic Disorder Allowable Exclusions:  Death  Permanent Nursing Home Resident  Hospice or Palliative Care  Personality Disorder  Pervasive Developmental Disorder Recommendation For 2020 Report Year (dates of index event 1/1/2018 to 12/31/2018) 1. Incorporate adolescents into the depression measures  Modify age range to include adolescents; age 12 and older  Report measures as two separate stratifications by age (not combined); ages 12 to 17 and ages 18 and older 2. Widen the follow‐up assessment window to +/‐ 60 days for all populations and all response and remission measures  Six month measures assessment window expands from 5 to 7 months  4 to 8 months  Twelve month measures assessment window expands from 11 to 13 months  10 to 14 months Page | 6 3. Patient Reported Outcome Tools for index/denominator and measuring outcomes of remission and response are the PHQ‐9 and PHQ‐9M  Add the PHQ‐9M as a PRO tool that can be used  Providers may elect to use either tool; no measure construct restriction for age 4. Modifications to exclusions include the following:  Personality disorders narrowed to emotionally labile conditions and moved to the allowable exclusion category  Add exclusion value set for schizophrenia or psychotic disorder as a required exclusion  Add exclusion value set for pervasive developmental disorder as an allowable exclusion 5. Remove denominator criteria for behavioral health settings that stipulates the diagnosis of major depression or dysthymia needs to be in the primary position.  Relates to new exclusion for schizophrenia or psychotic disorder; no longer necessary 2016 Depression Measure Development Workgroup Name Member Type
Organization
Michael Trangle, MD Clinical Provider; Psychiatrist; Chair
Health Partners Medical Group
Mark Williams, MD Clinical Provider; Psychiatrist
Mayo Clinic
Parnjai Johnson, MD Clinical Provider; Psychiatrist
Park Nicollet Clinic David Rossmiller, MD Clinical Provider; Family Medicine
Entira Family Clinics Shannon Neale, MD Clinical Provider; Family Medicine
Park Nicollet Clinic Laura Saliterman, MD Clinical Provider; Pediatrics/ MARC
South Lake Pediatrics
Amelia Versland, PhD Clinical Provider; Psychologist
Hennepin County Medical Center
Julie Erickson, PhD LP Clinical Provider; Psychologist
Children's Minnesota Dianne Burd, MSW LICSW Clinical Provider, Social Worker
Gillette Children’s Specialty Health
Terry Murray, MEd Data Analyst Allina Health
Leif Solberg, MD Quality Improvement/ Family Medicine
HealthPartners Institute Wendy Scheckel, RN Quality Improvement
Olmsted Medical Center Terri Lloyd, BSN MA Clinic Administration
Children's Health Network Cara Broich, RN CPHQ Health Plan/ Quality Improvement
Medica
Kimberley Witczak Consumer Co‐Founder Woody Matters Collette Pitzen Facilitator/ Measure Development
MN Community Measurement
Jasmine Larson Measure Development
MN Community Measurement
1
National Institute Mental Health/ National Institute Health 2014 prevalence of depression in adolescents statistics www.nimh.nih.gov/health/statistics/prevalence/major‐depression‐among‐adolescents.shtml 2
2013 Youth Risk Behavior Survey Suicide and suicide Attempts in Adolescents Clinical Report American Academy of Pediatrics July 2016 3
Why do many psychiatric disorders emerge during adolescence? Giedd et al. Nat Rev Neurosci Dec 2008 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2762785/ 4
New Measures Evaluate Rates of Obesity Counseling for Kids, Depression Screening for Teens Oct 2015 www.mncm.org/new‐measures‐
evaluate‐rates‐of‐obesity‐counseling‐for‐kids‐depression‐screening‐for‐teens/ 5
Often mislabeled as the PHQ‐A. PHQ‐A is actually has 80+ questions and no numeric scoring www.phqscreeners.com 6
CES‐D, CDI‐2 SR, Columbia, Cornell, DEPS, DUKE‐AD, GDS, MQF, OQ 45.2, PSC‐17, PCS‐35, PSC‐35 YSR 7
PROMIS SF 8b, CUDOS, QIDS‐SR‐16, BDI‐II, BDI‐FS 8
The Link Between Depression and Other Mental Illnesses National Institute of Mental Health American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSM‐V. Fieve, R. Bipolar II, Rodale Books, 2006. Page | 7 Depression Care: Remission at Six Months Specifications DRAFT  for MARC Review and Discussion 2020 Report Year 01/01/2018 to 12/31/2018 Dates of Index Description The percentage of adolescent patients (12 to 17 years of age) and adult patients (18 years of age or older) with Major Depression or Dysthymia who reached remission six months (+/‐ 60 days) after an index visit Measurement Period Index Period: January 1 through December 31, 2018 Assessment Period: May 2, 2018 through August 29, 2019 Eligible Population Eligible Specialties Family Medicine, Internal Medicine, Geriatric Medicine, Psychiatry, Behavioral Health, Pediatric/Adolescent Medicine Eligible Providers Medical Doctor (MD), Doctor of Osteopathy (DO), Physician Assistant (PA), Advanced Practice Registered Nurses (APRN) If a physician is on site, these providers are also eligible: Licensed Psychologist (LP), Licensed Independent Clinical Social Worker (LICSW), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage & Family Therapist (LMFT) Ages 12 years of age or older at the index visit Event (Index Visit) An index visit occurs when ALL of the following criteria are met during a face‐to‐face visit or contact with an eligible provider in an eligible specialty: 
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a PHQ‐9 or PHQ‐9M result greater than nine an active diagnosis of Major Depression or Dysthymia** (Major Depression or Dysthymia Value Set)  the patient is NOT in a prior index period An index period begins with an index visit and is 14 months in duration. **For psychiatry providers and behavioral health providers with a psychiatrist on site: the diagnosis of Major Depression or Dysthymia must be the primary diagnosis.  REMOVE Denominator The eligible population Numerator The number of patients in the denominator who reached remission, with a PHQ‐9 or PHQ‐9M result less than five, six months (+/‐ 60 days) after an index visit Required Exclusions The following exclusions must be applied to the eligible population:  Patient had an active diagnosis of Bipolar Disorder (Bipolar Disorder Value Set)  Patient had an active diagnosis of Schizophrenia or Psychotic Disorder (Schizophrenia Psychotic Disorder Value Set) Helpline: 612‐746‐4522 | E‐mail: [email protected] | Data Portal: https://data.mncm.org/login © MN Community Measurement, 2016. All rights reserved. Page 1 Depression Care: Remission at Six Months Specifications DRAFT  for MARC Review and Discussion 2020 Report Year 01/01/2018 to 12/31/2018 Dates of Index Allowable Exclusions The following exclusions are allowed to be applied to the eligible population:  Patient was a permanent nursing home resident at any time during the measurement period  Patient was in hospice or receiving palliative care at any time during the measurement period  Patient died prior to the end of the measurement period  Patient had an active diagnosis of Personality Disorder (Personality Disorder Value Set (move from required to allowable)  and MODIFIED  Patient had an active diagnosis of Pervasive Developmental Disorder (Pervasive Disorder Value Set) Measure Scoring Rate/Proportion Results are always stratified by age: 
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Depression Remission, Adolescents (12‐17 years of age) Depression Remission, Adults (18 years of age and older) Interpretation of Score Higher score indicates better quality Measure Type Outcome Please Note: No determination has been made about implementation in MN, voluntary inclusion of adolescents and pediatric/adolescent medicine or incorporating changes into MDH’s legislated Statewide Quality Reporting and Measurement System (SQRMS). Timeframes for Technical Changes Index Dates 6 mo follow‐up window 6mo ‐ Xdays 6mo + Xdays
2017 RY 2018 RY 2019 RY 2020 RY 2021 RY 1/1/2015 1/1/2016 1/1/2017 1/1/2018 1/1/2019 12/31/2015 12/31/2016 12/31/2017 12/31/2018 12/31/2019 6/1/2015 6/1/2016 6/1/2017 5/2/2018 5/2/2019 2022 RY 1/1/2020 12/31/2020 5/2/2020 2017 RY 2018 RY 2019 RY 2020 RY 2021 RY 2022 RY DOS for Submission 2/1/2016 1/31/2017 2/1/2017 1/31/2018 2/1/2018 1/31/2019 2/1/2019 2/29/2020 3/1/2020 3/1/2021 3/2/2021 3/1/2022 12mo follow‐up window 12mo ‐ Xdays 12mo + Xdays
7/30/2016
7/30/2017
7/30/2018
8/29/2019
8/29/2020
12/2/2015 12/2/2016 12/2/2017 11/2/2018 11/2/2019 1/30/2017
1/30/2018
1/30/2019
2/29/2020
3/1/2021
30 day 30 day 30 day 60 day 60 day 8/29/2021
11/2/2020 3/1/2022
60 day • Begin collecting first adolescent indexes in 2018RY (1/2018 only) for reporting of adolescent 6 & 12 mo rates in 2020. Portal would require modification between 2017RY and 2018RY to accept pts <18yo. • Widen follow‐up window and recalculate submitted contacts in Portal after 2019RY data passed. Seven months of 6‐month follow‐ups and two months of 12‐
month follow‐ups will already have been submitted in 2019 for 2020 reporting. Prepare displays, feeds, downloads for adolescent results in 2020. • Extend DOS submitted in 2020RY to 13 months to accommodate widening of follow‐up period. • Return to 12 month submission (three 4‐month measure periods) in 2021RY. Dates will need to ebb and flow with leap years. Helpline: 612‐746‐4522 | E‐mail: [email protected] | Data Portal: https://data.mncm.org/login © MN Community Measurement, 2016. All rights reserved. Page 2 Depression Care: Remission at Six Months Specifications DRAFT  for MARC Review and Discussion 2020 Report Year 01/01/2018 to 12/31/2018 Dates of Index Exclusion Changes‐ Decision Tables for Illustration Key for code by code recommendations: Keep = a particular code was previsouly part of the value set and the code (and condition) will remain in the value set. These patients will continue to be excluded from the denominator. Remove = a particular code was previsouly part of the value set for exclusion from the denominator. Was reviewed by the workgroup and is no longer considered appropriate for exclusion. Patients with these conditions can have depression and their symptoms related to another condition do not prevent them from being able to answer a PHQ‐9 accurately. These codes and conditions will no longer be specified as exclusions form the denominator Add = two additional values sets were recommended by NCQA with the incorporation of adolescents. These value sets were accepted as future exclusions for the denominator. Bipolar Disorder (required exclusion) No changes to value set. Personality Disorders (allowable exclusion) ICD‐10 ICD‐9 Code Description F34.0 301.13 Cyclothymic disorder F60.3 301.83 Borderline personality disorder F60.4 301.50 Histrionic personality disorder F68.11 na Factitious disorder w predom psychological symptoms F68.12 301.51 Factitious disorder w predom physical symptoms F68.13 na Factitious disorder w combined psych and physical symptoms F68.10 na Factitious disorder, unspecified F60.2 301.7 Antisocial personality disorder F60.81 301.81 Narcissistic personality disorder F21 301.22 Schizotypal disorder F60.0 301.0 Paranoid personality disorder F60.1 301.20 Schizoid personality disorder F60.5 301.4 Obsessive‐compulsive personality F60.6 301.82 Avoidant personality disorder F60.7 301.6 Dependent personality disorder F60.89 301.89 Other specific personality disorders F60.9 301.9 Personality disorder, unspecified * Additionally remove all ICD‐9 codes without an equivalent ICD‐10 code Pervasive Developmental Disorders (allowable exclusion) ICD‐10 Definition F84.0 Autistic disorder F84.3 Other childhood disintegrative disorder F84.8 Other pervasive developmental disorders F84.9 Pervasive developmental disorder, unspecified Recommend Keep Keep Keep Keep Keep Keep Keep Remove Remove Remove Remove Remove Remove Remove Remove Remove Remove Recommend Add Add Add Add Helpline: 612‐746‐4522 | E‐mail: [email protected] | Data Portal: https://data.mncm.org/login © MN Community Measurement, 2016. All rights reserved. Page 3 Depression Care: Remission at Six Months Specifications DRAFT  for MARC Review and Discussion 2020 Report Year 01/01/2018 to 12/31/2018 Dates of Index Schizophrenia Psychotic Disorders (required exclusion) ICD‐10 Code Description F20.0 Paranoid schizophrenia F20.1 Disorganized schizophrenia F20.2 Catatonic schizophrenia F20.3 Undifferentiated schizophrenia F20.5 Residual schizophrenia F20.81 Schizophreniform disorder F20.89 Other schizophrenia F20.9 Schizophrenia, unspecified F23 Brief psychotic disorder F25.0 Schizoaffective disorder, bipolar type F25.1 Schizoaffective disorder, depressive type F25.8 Other schizoaffective disorders F25.9 Schizoaffective disorder, unspecified F28 Other psychotic disorder not due to a substance or known physiological condition Recommend Add Add Add Add Add Add Add Add Add Add Add Add Add Add Helpline: 612‐746‐4522 | E‐mail: [email protected] | Data Portal: https://data.mncm.org/login © MN Community Measurement, 2016. All rights reserved. Page 4