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Follow-Up After Emergency Department Visit for Mental Illness (FUM)

HEDIS Measure

Follow-Up After Emergency Department Visit for Mental Illness (FUM)

Line of business: Commercial Medicaid Medicare

Data Collection Method: Administrative

Measure Description

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).

Numerator Compliance

30-Day Follow-Up - A follow-up visit with any practitioner, with a principal diagnosis of a mental health disorder or with a principal diagnosis of intentional self-harm and any diagnosis of a mental health disorder within 30 days after the ED visit (31 total days). Include visits that occur on the date of the ED visit.

7-Day Follow-Up - A follow-up visit with any practitioner, with a principal diagnosis of a mental health disorder or with a principal diagnosis of intentional self-harm and any diagnosis of a mental health disorder within 7 days after the ED visit (8 total days). Include visits that occur on the date of the ED visit.

For both indicators, any of the following meet criteria for a follow-up visit:

  • Outpatient, BH outpatient visit, intensive outpatient encounter, partial hospitalization or community mental health center visit with a principal diagnosis of a mental health disorder.
  • Electroconvulsive therapy with a principal diagnosis of a mental health disorder
  • Telehealth, observation, telephone, e-visit, virtual check- in visit with a principal diagnosis of a mental health disorder
  • Outpatient visit, intensive outpatient encounter, partial hospitalization or community mental health center visit, with a principal diagnosis of intentional self-harm, with any diagnosis of a mental health disorder
  • Electroconvulsive therapy with a principal diagnosis of intentional self-harm, with any diagnosis of a mental health disorder
  • Telehealth, observation, telephone, e-visit or virtual check-in with a principal diagnosis of intentional self-harm, with any diagnosis of a mental health disorder

Best Practices

  • Schedule follow-up appointments as soon as possible, particularly those patients recently discharged from the ED
  • Train patients and staff on the “Teach Back Method” to ensure patients and caregivers review and understand discharge instructions and the next steps in their care for follow–up
  • Encourage the patient to bring their discharge paperwork to their first appointment
  • Educate the patient about the importance of follow-up and adherence to treatment recommendations
  • Coordinate care with behavioral health practitioners by sharing progress notes and updates
  • Outreach patients who cancel appointments and assist them with rescheduling as soon as possible
  • Set flags if available in EHR or develop tracking method for patients due or past due for follow-up after discharge visits and require staff to follow up with patients that miss or cancel their appointment
  • Use the same diagnosis for mental illness at each follow up (a non-mental illness diagnosis code will not fulfill this measure)

Quality Value Set Directory Coding Tips

Ambulatory Surgical Center POS

POS

  • 24

BH Outpatient

CPT

  • 98960
  • 98961
  • 98962
  • 99078
  • 99201
  • 99202
  • 99203
  • 99204
  • 99205
  • 99211
  • 99212
  • 99213
  • 99214
  • 99215
  • 99241
  • 99242
  • 99243
  • 99244
  • 99245
  • 99341
  • 99342
  • 99343
  • 99344
  • 99345
  • 99347
  • 99348
  • 99349
  • 99350
  • 99381
  • 99382
  • 99383
  • 99384
  • 99385
  • 99386
  • 99387
  • 99391
  • 99392
  • 99393
  • 99394
  • 99395
  • 99396
  • 99397
  • 99401
  • 99402
  • 99403
  • 99404
  • 99411
  • 99412
  • 99483
  • 99492
  • 99493
  • 99494
  • 99510

HCPCS

  • G0155
  • G0176
  • G0177
  • G0409
  • G0463
  • G0512
  • H0002
  • H0004
  • H0031
  • H0034
  • H0036
  • H0037
  • H0039
  • H0040
  • H2000
  • H2010
  • H2011
  • H2013
  • H2014
  • H2015
  • H2016
  • H2017
  • H2018
  • H2019
  • H2020
  • T1015

SNOMED CT US Edition

  • 77406008
  • 84251009
  • 185463005
  • 185464004
  • 185465003
  • 281036007
  • 391223001
  • 391224007
  • 391225008
  • 391233009
  • 391237005
  • 391239008
  • 391242002
  • 391257009
  • 391260002
  • 391261003
  • 439740005
  • 3391000175108
  • 444971000124105

UBREV

  • 0510
  • 0513
  • 0515
  • 0516
  • 0517
  • 0519
  • 0520
  • 0521
  • 0522
  • 0523
  • 0526
  • 0527
  • 0528
  • 0529
  • 0900
  • 0902
  • 0903
  • 0904
  • 0911
  • 0914
  • 0915
  • 0916
  • 0917
  • 0919
  • 0982
  • 0983

Community Mental Health Center POS

POS

  • 53

Electroconvulsive Therapy

CPT

  • 90870

ICD10PCS

  • GZB0ZZZ
  • GZB1ZZZ
  • GZB2ZZZ
  • GZB3ZZZ
  • GZB4ZZZ

SNOMED CT US Edition

  • 10470002
  • 11075005
  • 23835007
  • 231079005
  • 231080008
  • 284468008
  • 313019002
  • 313020008
  • 1010696002
  • 1010697006

Intentional Self-Harm

* Per NCQA HEDIS Specifications there are over 900 codes - For additional codes, please email BH_HEDISTeam@HorizonBlue.com

ICD10CM

  • T14.91XA
  • T14.91XD
  • T14.91XS
  • T36.0X2A
  • T36.0X2D
  • T36.0X2S
  • T36.1X2A
  • T36.1X2D
  • T36.1X2S
  • T36.2X2A
  • T36.2X2D
  • T36.2X2S
  • T36.3X2A
  • T36.3X2D
  • T36.3X2S
  • T36.4X2A
  • T36.4X2D
  • T36.4X2S
  • T36.5X2A
  • T36.5X2D
  • T36.5X2S
  • T36.6X2A
  • T36.6X2D
  • T36.6X2S
  • T36.7X2A
  • T36.7X2D
  • T36.7X2S
  • T36.8X2A
  • T36.8X2D
  • T36.8X2S
  • T36.92XA
  • T36.92XD
  • T36.92XS
  • T37.0X2A
  • T37.0X2D
  • T37.0X2S
  • T37.1X2A
  • T37.1X2D
  • T37.1X2S
  • T37.2X2A
  • T37.2X2D
  • T37.2X2S
  • T37.3X2A
  • T37.3X2D
  • T37.3X2S
  • T37.4X2A
  • T37.4X2D
  • T37.4X2S
  • T37.5X2A
  • T37.5X2D
  • T37.5X2S
  • T37.8X2A
  • T37.8X2D
  • T37.8X2S
  • T37.92XA
  • T37.92XD
  • T37.92XS
  • T38.0X2A
  • T38.0X2D
  • T38.0X2S
  • T38.1X2A
  • T38.1X2D
  • T38.1X2S
  • T38.2X2A
  • T38.2X2D
  • T38.2X2S
  • T38.3X2A
  • T38.3X2D
  • T38.3X2S
  • T38.4X2A
  • T38.4X2D
  • T38.4X2S
  • T38.5X2A
  • T38.5X2D
  • T38.5X2S
  • T38.6X2A
  • T38.6X2D
  • T38.6X2S
  • T38.7X2A
  • T38.7X2D
  • T38.7X2S
  • T38.802A
  • T38.802D
  • T38.802S
  • T38.812A
  • T38.812D
  • T38.812S
  • T38.892A
  • T38.892D
  • T38.892S
  • T38.902A
  • T38.902D
  • T38.902S
  • T38.992A
  • T38.992D
  • T38.992S
  • T39.012A
  • T39.012D
  • T39.012S
  • T39.092A
  • T39.092D
  • T39.092S
  • T39.1X2A
  • T39.1X2D
  • T39.1X2S
  • T39.2X2A
  • T39.2X2D
  • T39.2X2S
  • T39.312A
  • T39.312D
  • T39.312S
  • T39.392A
  • T39.392D
  • T39.392S
  • T39.4X2A
  • T39.4X2D
  • T39.4X2S
  • T39.8X2A
  • T39.8X2D
  • T39.8X2S
  • T39.92XA
  • T39.92XD
  • T39.92XS
  • T40.0X2A
  • T40.0X2D
  • T40.0X2S
  • T40.1X2A
  • T40.1X2D
  • T40.1X2S
  • T40.2X2A
  • T40.2X2D
  • T40.2X2S

ICD10CM

  • T40.3X2A
  • T40.3X2D
  • T40.3X2S
  • T40.412A
  • T40.412D
  • T40.412S
  • T40.422A
  • T40.422D
  • T40.422S
  • T40.492A
  • T40.492D
  • T40.492S
  • T40.4X2A
  • T40.4X2D
  • T40.4X2S
  • T40.5X2A
  • T40.5X2D
  • T40.5X2S
  • T40.602A
  • T40.602D
  • T40.602S
  • T40.692A
  • T40.692D
  • T40.692S
  • T40.7X2A
  • T40.7X2D
  • T40.7X2S
  • T40.8X2A
  • T40.8X2D
  • T40.8X2S
  • T40.902A
  • T40.902D
  • T40.902S

Mental Health Diagnosis

* Per NCQA HEDIS Specifications there are over 900 codes - For additional codes, please email BH_HEDISTeam@HorizonBlue.com

ICD10CM

  • F03.90
  • F03.91
  • F20.0
  • F20.1
  • F20.2
  • F20.3
  • F20.5
  • F20.81
  • F20.89
  • F20.9
  • F21
  • F22
  • F23
  • F24
  • F25.0
  • F25.1
  • F25.8
  • F25.9
  • F28
  • F29
  • F30.10
  • F30.11
  • F30.12
  • F30.13
  • F30.2
  • F30.3
  • F30.4
  • F30.8
  • F30.9
  • F31.0
  • F31.10
  • F31.11
  • F31.12
  • F31.13
  • F31.2
  • F31.30
  • F31.31
  • F31.32
  • F31.4
  • F31.5
  • F31.60
  • F31.61
  • F31.62
  • F31.63
  • F31.64
  • F31.70
  • F31.71
  • F31.72
  • F31.73
  • F31.74
  • F31.75
  • F31.76
  • F31.77
  • F31.78
  • F31.81
  • F31.89
  • F31.9
  • F32.0
  • F32.1
  • F32.2
  • F32.3
  • F32.4
  • F32.5
  • F32.8
  • F32.81
  • F32.89
  • F32.9
  • F33.0
  • F33.1
  • F33.2
  • F33.3
  • F33.40
  • F33.41
  • F33.42
  • F33.8
  • F33.9
  • F34.0
  • F34.1
  • F34.8
  • F34.81
  • F34.89
  • F34.9
  • F39
  • F40.00
  • F40.01
  • F40.02
  • F40.10
  • F40.11
  • F40.210
  • F40.218
  • F40.220
  • F40.228
  • F40.230
  • F40.231
  • F40.232
  • F40.233
  • F40.240
  • F40.241
  • F40.242
  • F40.243
  • F40.248
  • F40.290
  • F40.291
  • F40.298
  • F40.8
  • F40.9
  • F41.0
  • F41.1
  • F41.3
  • F41.8
  • F41.9
  • F42
  • F42.2
  • F42.3
  • F42.4
  • F42.8
  • F42.9
  • F43.0
  • F43.10
  • F43.11
  • F43.12
  • F43.20
  • F43.21
  • F43.22
  • F43.23
  • F43.24
  • F43.25
  • F43.29
  • F43.8
  • F43.9
  • F44.0
  • F44.1
  • F44.2
  • F44.4
  • F44.5
  • F44.6
  • F44.7
  • F44.81
  • F44.89
  • F44.9
  • F45.0
  • F45.1
  • F45.20
  • F45.21
  • F45.22
  • F45.29
  • F45.41
  • F45.42
  • F45.8
  • F45.9
  • F48.1
  • F48.2
  • F48.8
  • F48.9
  • F50.00
  • F50.01
  • F50.02
  • F50.2
  • F50.8
  • F50.81
  • F50.82
  • F50.89
  • F50.9
  • F51.01
  • F51.02

* Per NCQA HEDIS Specifications there are over 900 codes - For additional codes, please email BH_HEDISTeam@HorizonBlue.com

SNOMED CT US Edition

  • 109006
  • 162004
  • 281004
  • 568005
  • 596004
  • 600009
  • 832007
  • 1145003
  • 1196001
  • 1376001
  • 1380006
  • 1383008
  • 1499003
  • 1686006
  • 1816003
  • 1855002
  • 1973000
  • 2312009
  • 2506003
  • 2618002
  • 2815001
  • 3109008
  • 3158007
  • 3503000
  • 3530005
  • 3586005
  • 4306003
  • 4441000
  • 4817008
  • 4863002
  • 4926007
  • 4932002
  • 4949009
  • 4997005
  • 5095008
  • 5158005
  • 5464005
  • 5509004
  • 5510009
  • 5664002
  • 5703000
  • 6475002
  • 7025000
  • 7291006
  • 7397008
  • 7461003
  • 7794004
  • 8185002
  • 8511007
  • 8522006
  • 9083002
  • 9167000
  • 9340000
  • 9345005
  • 9674006
  • 10278007
  • 10327003
  • 10349009
  • 10532003
  • 10586006
  • 10783000
  • 10875004
  • 10981006
  • 11806006
  • 11941006
  • 12348006
  • 12939007
  • 12969000
  • 13313007
  • 13438001
  • 13581000
  • 13601005
  • 13670005
  • 13746004
  • 14070001
  • 14077003
  • 14144000
  • 14183003
  • 14291003
  • 14495005
  • 15193003
  • 15639000
  • 15662003
  • 15840001
  • 15945005
  • 15977008
  • 16295005
  • 16506000
  • 16805009
  • 16966009
  • 16990005
  • 17155009
  • 17226007
  • 17262008
  • 17496003
  • 17782008
  • 17961008
  • 18003009
  • 18085000
  • 18186001
  • 18193002
  • 18260003
  • 18393005
  • 18478005
  • 18573003
  • 18818009
  • 18941000
  • 19300006
  • 19527009
  • 19694002
  • 19766004
  • 19922006
  • 20010003
  • 20250007
  • 20385005
  • 20734000
  • 20960007
  • 21586000
  • 21897009
  • 21900002
  • 22121000
  • 22230001
  • 22407005
  • 22419002
  • 23148009
  • 23560001
  • 23645006
  • 23772009
  • 24121004
  • 24315006
  • 24781009
  • 25501002
  • 25766007
  • 25772007
  • 25922000
  • 25971005
  • 26025008
  • 26203008
  • 26472000
  • 26516009
  • 26530004
  • 26665006
  • 26852004
  • 26929004
  • 27387000
  • 27544004
  • 27720003
  • 28357009
  • 28475009
  • 28663008
  • 28676002
  • 28857002
  • 28864000
  • 28884001
  • 29599000
  • 29733004
  • 29929003
  • 30059008
  • 30077003
  • 30336007
  • 30491001
  • 30509009
  • 30520009
  • 30605009
  • 30687003

Observation

CPT

  • 99217
  • 99218
  • 99219
  • 99220

Online Assessments

CPT

  • 98969
  • 98970
  • 98971
  • 98972
  • 99421
  • 99422
  • 99423
  • 99444
  • 99457

HCPCS

  • G0071
  • G2010
  • G2012
  • G2061
  • G2062
  • G2063

POS

  • 03
  • 05
  • 07
  • 09
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 22
  • 33
  • 49
  • 50
  • 71
  • 72

Partial Hospitalization or Intensive Outpatient

HCPCS

  • G0410
  • G0411
  • H0035
  • H2001
  • H2012
  • S0201
  • S9480
  • S9484
  • S9485

SNOMED CT US Edition

  • 7133001
  • 305345009
  • 305346005
  • 305347001
  • 391038005
  • 391042008
  • 391043003
  • 391046006
  • 391047002
  • 391048007
  • 391054008
  • 391055009
  • 391056005
  • 391133003
  • 391150001
  • 391151002
  • 391152009
  • 391153004
  • 391170007
  • 391185001
  • 391186000
  • 391187009
  • 391188004
  • 391191004
  • 391192006
  • 391194007
  • 391195008
  • 391207001
  • 391208006
  • 391209003
  • 391210008
  • 391211007
  • 391228005
  • 391229002
  • 391232004
  • 391252003
  • 391254002
  • 391255001
  • 391256000

UBREV

  • 0905
  • 0907
  • 0912
  • 0913

Telehealth POS

POS

  • 02

Telephone Visits

CPT

  • 98966
  • 98967
  • 98968
  • 99441
  • 99442
  • 99443

SNOMED CT US Edition

  • 185317003
  • 314849005
  • 386472008
  • 386473003
  • 401267002

Visit Setting Unspecified

CPT

  • 90791
  • 90792
  • 90832
  • 90833
  • 90834
  • 90836
  • 90837
  • 90838
  • 90839
  • 90840
  • 90845
  • 90847
  • 90849
  • 90853
  • 90875
  • 90876
  • 99221
  • 99222
  • 99223
  • 99231
  • 99232
  • 99233
  • 99238
  • 99239
  • 99251
  • 99252
  • 99253
  • 99254
  • 99255