Measure #6: Screening for Depressive Symptoms Dementia

Measure Description Percentage of patients, regardless of age, with a diagnosis of dementia who were screened for depressive symptoms within a 12 month period

Measure Components Numerator Statement

Patients who were screened for depressive symptoms* within a 12 month period *Depressive symptoms in a patient with dementia can include: anxiety, sadness, lack of reactivity to pleasant events, irritability, agitation, retardation, multiple physical complaints, acute loss of interest, appetite loss, lack of energy, diurnal variation of mood, difficulty falling asleep, multiple awakenings, during sleep, early morning awakenings, suicide, self-depreciation, pessimism, mood congruent delusions.68 Since patients may be unable to describe their symptoms, caregiver report of depressive symptoms should be reviewed and included in the screen for depressive symptoms. In addition to clinical qualitative approaches, dementia patients can be screened for depressive symptoms using one of a number of valid, reliable instruments available from the medical literature. Examples include, but are not limited to: Cornell Scale for Depression in Dementia Geriatric Depression Scale [Note: a short form is also available.] PHQ-9

Denominator Statement

All patients, regardless of age, with a diagnosis of dementia

Denominator Exceptions

None

Supporting Guideline & Other References

The following evidence statements are quoted verbatim from the referenced clinical guidelines: Depression is a common, treatable comorbidity in patients with dementia and should be screened for (Guideline). (AAN, 2001)18 Ongoing assessment includes periodic monitoring of the development and evolution of cognitive and noncognitive psychiatric symptoms and their response to intervention (Category I)…Among the neuropsychiatric symptoms that require ongoing assessment are depression (including major depression and other depressive syndromes), suicidal ideation or behavior, hallucinations, delusions, agitation, aggressive behavior, disinhibition, sexually inappropriate behavior, anxiety, apathy, and disturbances of appetite and sleep. (APA, 2007)21 Conduct and document an assessment and monitor changes in behavioral symptoms, psychotic symptoms, or depression…It is important for health care professionals to be sensitive to symptoms of affective disorders associated with Alzheimer’s Disease and to facilitate early intervention…Since administering assessment tests for depression to Alzheimer’s Disease patients is often challenging and patients may be unable to describe their symptoms to the [primary care practitioner], gathering data from family members becomes especially important…The Cornell Scale for Depression in Dementia is a useful tool for providers because it captures both patient and caregiver input. (California Workgroup on Guidelines for Alzheimer’s Disease Management, 2008)24 In patients with serious illness at the end of life, clinicians should regularly assess patients for pain, dyspnea, and depression. (Grade: strong recommendation, moderate

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quality of evidence.) (ACP, 2008)69

Measure Importance Relationship to desired outcome

Opportunity for Improvement

IOM Domains of Health Care Quality Addressed Exception Justification Harmonization with Existing Measures

Depression is one of the most common co-occurring psychiatric conditions in dementia patients, affecting over 50% of patients with Alzheimer’s disease.42 Depression can be reliably detected and quantified, and can be differentiated from the other neuropsychiatric symptoms of dementia.70 The impact of depression is significant with even mild levels of depression in dementia patients associated with higher rates of disability, impaired quality of life, and greater mortality.21 In particular, Alzheimer’s disease patients with depression have demonstrated “significantly more severe apathy, delusions, anxiety, pathological affective crying, irritability, deficits in activities of daily living, impairments in social functioning, and parkinsonism than Alzheimer’s disease patients without depression.”42 Furthermore, with increasing severity of depression, the severity of psychopathological and neurological impairments in dementia patients increases.42 Identifying depression in patients with dementia is therefore essential for early intervention and proper management. A recent study examining the variability between clinical subspecialties in the outpatient evaluation and treatment of dementia reviewed medical records of 1,401 patients with dementia. They found that 63.4% of patients were given formal instruments for depression screening.71 Similar results were reported in a 2007 analysis of medical records and caregiver surveys for 378 patients with dementia with 73% of patients receiving an assessment of behavioral problems or depression in the previous 12 months.6 x Equitable x Effective

This measure has no exceptions. Harmonization with existing measures was not applicable to this measure.

Measure Designation Measure purpose Type of measure Level of Measurement Care setting Data source

x x x x

Quality improvement Accountability Process Individual practitioner

x x x x x x

Ambulatory care Residential (ie, nursing facility, domiciliary, home care) Electronic health record (EHR) data Administrative Data/Claims (inpatient or outpatient claims) Administrative Data/Claims Expanded (multiple-source) Paper medical record

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Administrative Claims Specifications PCPI APPROVED

Dementia

Measure #6 – Screening for Depressive Symptoms Denominator (Eligible Population)

All patients, regardless of age, with a diagnosis of dementia ICD-9-CM Diagnosis Codes:

Code Descriptor Neurosyphilis 094.1 Neurosyphilis, General paresis Dementias 290.0 Senile dementia, uncomplicated 290.10 Presenile dementia, uncomplicated 290.11 Presenile dementia with delirium 290.12 Presenile dementia with delusional features 290.13 Presenile dementia with depressive features 290.20 Senile dementia with delusional features 290.21 Senile dementia with depressive features 290.3 Senile dementia with delirium 290.40 Vascular dementia, uncomplicated 290.41 Vascular dementia with delirium 290.42 Vascular dementia with delusions 290.43 Vascular dementia with depressed mood 290.8 Other specified senile psychotic conditions 290.9 Unspecified senile psychotic condition Persistent Mental Disorders due to Conditions Classified Elsewhere 294.10 Dementia in conditions classified elsewhere without behavioral disturbance 294.11 Dementia in conditions classified elsewhere with behavioral disturbance 294.20 Dementia, unspecified, without behavioral disturbance 294.21 Dementia, unspecified, with behavioral disturbance 294.8 Other persistent mental disorders due to conditions classified elsewhere Other cerebral degenerations 331.0 Alzheimer’s disease 331.11 Pick’s disease 331.19 Other frontotemporal dementia 331.82 Dementia with Lewy bodies

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Administrative Claims Specifications PCPI APPROVED

Dementia Denominator (Eligible Population) Continued

ICD-10-CM Diagnosis Codes:

Code Descriptor Late Syphilis A52.17 Symptomatic neurosyphilis, General paresis Vascular Dementia F01.50 Vascular dementia without behavioral disturbance F01.51 Vascular dementia with behavioral disturbance Dementia in Other Diseases Classified Elsewhere F02.80 Dementia in other diseases classified elsewhere, without behavioral disturbance F02.81 Dementia in other diseases classified elsewhere, with behavioral disturbance Unspecified Dementia F03 Unspecified dementia Delirium due to Known Physiological Condition F05 Delirium due to unknown physiological condition Other Mental Disorders Due to Known Physiological Condition F06.0 Psychotic disorder with hallucinations due to known physiological condition F06.8 Other specified mental disorders due to known physiological condition Alzheimer’s Disease G30.0 Alzheimer’s disease with early onset G30.1 Alzheimer’s disease with late onset G30.8 Other Alzheimer’s disease G30.9 Alzheimer’s disease, unspecified Other Degenerative Diseases of Nervous System, Not Elsewhere Classified G31.01 Pick’s disease G31.09 Other frontotemporal dementia G31.83 Dementia with Lewy bodies AND CPT® Code: x x x x x x x x x x x x x x

90801, 90802 90804, 90805, 90806, 90807, 90808, 90809 90810, 90811, 90812, 90813, 90814, 90815 90816, 90817, 90818, 90819, 90821, 90822 90823, 90824, 90826, 90827, 90828, 90829 90862 96101, 96102, 96103 96116, 96118, 96119, 96120 96150, 96151 97003, 97004 99201, 99202, 99203, 99204, 99205 99212, 99213, 99214, 99215 99241, 99242, 99243, 99244, 99245 99304, 99305, 99306

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Administrative Claims Specifications PCPI APPROVED

Dementia x x x x

x Numerator

99307, 99308, 99324, 99325, 99334, 99335, 99341, 99342, 99347, 99348,

99309, 99310 99326, 99327, 99328 99336, 99337 99343, 99344, 99345 99349, 99350

Patients who were screened for depressive symptoms within a 12 month period Please refer to the Measure Set Worksheets for complete numerator definition. CPT Category II Code 3725F: Screening for depression performed

Denominator Exceptions Additional CPT Category II Codes used to report this measure Reporting Instructions

None

None

Report 3725F if patient was screened for depressive symptoms. There are no performance exceptions for this measure; modifiers 1P, 2P or 3P may not be used.

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