Fewer repeat visits to the emergency room with follow-up care

According to an NCQA finding, research suggests that patients who received follow-up care after an emergency department visit for a mental health condition were less likely to have a repeat visit. Patients also benefited from follow-up care through improved physical and mental function and were more likely to stick to their follow-up care instructions.[i]

In 2019, fewer than half those prescribed follow-up care within seven days of an emergency department visit followed through with the recommended care instructions. There were significant increases in adherence to follow-up care instructions within the 30-day threshold as illustrated in the findings provided by NCQA.

Follow-up within 7 days of emergency department visit

Measurement Year	All Ages
2019	46.8%
2018	45.6%
2017	45.9%

 

Follow-up within 30 days of emergency department visit

Measurement Year	All Ages
2019	61.2%
2018	60.1%
2017	60.2%

 

Excerpt from NCQA FUM: https://www.ncqa.org/hedis/measures/followup-after-emergency-department-visit-for-mental-illness/
Follow these HEDIS® measures for additional guidance in closing the gaps in follow-up care after an emergency department visit for mental illness health conditions, alcohol or other drug abuse or disorder.

A note about telehealth

NCQA now accepts telehealth codes for behavioral health and some physical health measures. The modifiers 95 and GT are defined as telehealth services rendered via interactive audio and video telecommunications system.  CPT Codes 90791-90792, 90832-90834, 90836-90838, 90845, 90847, 98960-98962, 99201-99205, 99212-99215, 99231-99233, 99241-99245, 99251-99255, 99307-99310, 99406-99409 and 99495-99496 may be used for reporting synchronous (real-time) telemedicine services when appended by modifier 95.

 

Follow-up after emergency department visit for mental illness (FUM): The percentage of emergency department (ED) visits for members 6 years of age and older with a principal diagnosis of mental illness or intentional self-harm, who had a follow-up visit for mental illness. Two rates are reported:

• The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
• The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).

The follow-up visits, within 7 days and 30 days after hospitalization, can both be telehealth visits. Telephone visits alone do not meet this criterion.

 

FUM billing codes

Outpatient follow-up visits CPT: 90791-2, 90832-4, 90836-40, 90845, 90847, 90849, 90853, 90875-6, 98960-2, 98966-8, 99078, 99201-5, 99211-5, 99217-23, 99231-3, 99238-9, 99241-5, 99251-5, 99341-5, 99347-50, 99381-7, 99391-7, 99401-4, 99411-2, 99441-3, 99483, 99495-6, 99510

 

HCPCS: G0155, G0176-7, G0409, G0463, H0002, H0004, H0031, H0034, H0036-7, H0039-40, H2000, H2010-1, H2013-20, M0064, T1015

 

Mental illness diagnosis codes ICD-10: F03.9x, F20-25.xx, F28-34. xx, F39-45.xx, F48.xx, F50-53.xx, F59-60.xx, F63-66.xx, F68-69.xx, F80-82.xx, F84.xx, F88-93.xx, F95.xx, F98-99.xx

 

Intentional self-harm diagnosis codes ICD-10 example: T39.92XA

Other visits: 90791-90792, 90832-90834, 90836-90838, 90845, 90847, 99201-99205, 99212-99215, 99231-99233, 99241-99245, 99251-99255, 98960-98962

 

Telehealth modifier: 95 or GT

 

Telehealth modifier POS: 02

 

Follow-up after emergency department visit for alcohol and other drug abuse or dependence (FUA): The percentage of emergency department (ED) visits for members 13 years of age and older with a principal diagnosis of alcohol or other drug (AOD) abuse or dependence, who had a follow up visit for AOD. Two rates are reported:

• The percentage of ED visits for which the member received follow-up within 30 days of the ED visit (31 total days).
• The percentage of ED visits for which the member received follow-up within 7 days of the ED visit (8 total days).

The follow-up visits, within 7 days and 30 days after hospitalization, can both be telehealth visits. Telephone visits alone do not meet this criterion.

 

FUA billing codes:

Initiation, engagement and treatment follow-up visits CPT: 98960-2, 99078, 99201-5, 99211-5, 99241-5, 99341-50, 99384-7, 99394-7, 99401-4, 99408-9 99411-2, 99483, 99510

Alcohol counseling or other follow-up visits CPT: 99408-9 HCPCS: G0396-7, G0443, H0005, H0007, H0016, H0022, H0050, H2035-6, T1006, T1012 AOD

 

Medication treatment HCPCS: G2067-77, G2080, G2086-7, H0020, H0033, J0570, J0571-5, J2315, Q9991-2, S0109

 

Substance use disorder diagnosis codes ICD-10: F10-16.xx, F18-19.xx

 

Telehealth modifier: 95 or GT

 

Telephone visits: 98966 - 98968, 99441- 99443

 

Other visits: 90791-90792, 90832-90834, 90836-90838, 90845, 90847, 99201-99205, 99212-99215, 99231-99233, 99241-99245, 99251-99255, 99408-99409, 98960-98962

 

Telehealth modifier POS: 02

 

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA)

[1] https://www.ncqa.org/hedis/measures/follow-up-after-emergency-department-visit-for-mental-illness/

 

1136-0521-PN-GA