Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)
HEDIS Measure
Follow-Up After Emergency Department Visit for Alcohol and Other Drug Abuse or Dependence (FUA)
Line of business: Commercial Medicaid Medicare
Data Collection Method: Administrative (Claims)
Measure Description
The percentage of emergency department (ED) visits among members age 13 years and older with a principal diagnosis of substance use disorder (SUD), or any diagnosis of drug overdose, for which there was follow-up. 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 or a pharmacotherapy dispensing event within 30 days after the ED visit (31 total days). Include visits and pharmacotherapy events that occur on the date of the ED visit.
7-Day Follow-Up - A follow-up visit or a pharmacotherapy dispensing event within 7 days after the ED visit (8 total days). Include visits and pharmacotherapy events that occur on the date of the ED visit.
For both indicators, any of the following meet criteria for a follow-up:
- Outpatient, Intensive outpatient, partial hospitalization, non-residential substance abuse treatment facility, community mental health center visit or observation visit with any diagnosis of SUD, substance use or drug overdose or a mental health provider
- Peer support service with any diagnosis of SUD, substance use or drug overdose
- Opioid treatment service that bills monthly or weekly with any diagnosis of SUD, substance use or drug overdose
- Telehealth or Telephone visit with any diagnosis of SUD, substance use or drug overdose or with a mental health provider
- E-visit or virtual check-in with any diagnosis of SUD, substance use or drug overdose or with a mental health provider
- A substance use disorder service
- A behavioral health screening or assessment for SUD or mental health disorders
- A substance use service Pharmacotherapy dispensing event or medication treatment event
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
- Outreach to 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 AOD abuse or dependence at each follow-up (a non-mental illness diagnosis code will not fulfill this measure)
Description | Prescription |
Aldehyde dehydrogenase inhibitor |
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Antagonist |
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Other |
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Description | Prescription | Medication Lists |
Antagonist |
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Antagonist |
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Partial agonist |
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Partial agonist |
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Partial agonist |
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Partial agonist |
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Quality Value Set Directory Coding Tips
Per NCQA HEDIS Specifications there are additional codes - For additional codes, please email BH_HEDISTeam@HorizonBlue.com
AOD Abuse and Dependence
ICD10CM
- F10.10
- F10.120
- F10.121
- F10.129
- F10.130
- F10.131
- F10.132
- F10.139
- F10.14
- F10.150
- F10.151
- F10.159
- F10.180
- F10.181
- F10.182
- F10.188
- F10.19
- F10.20
- F10.220
- F10.221
- F10.229
- F10.230
- F10.231
- F10.232
- F10.239
- F10.24
- F10.250
- F10.251
- F10.259
- F10.26
- F10.27
- F10.280
- F10.281
- F10.282
- F10.288
- F10.29
- F11.10
- F11.120
- F11.121
- F11.122
- F11.129
- F11.13
- F11.14
- F11.150
- F11.151
- F11.159
- F11.181
- F11.182
- F11.188
- F11.19
- F11.20
- F11.220
- F11.221
- F11.222
- F11.229
- F11.23
- F11.24
- F11.250
- F11.251
- F11.259
- F11.281
- F11.282
- F11.288
- F11.29
- F12.10
- F12.120
- F12.121
- F12.122
- F12.129
- F12.13
- F12.150
- F12.151
- F12.159
- F12.180
- F12.188
- F12.19
- F12.20
- F12.220
- F12.221
- F12.222
- F12.229
- F12.23
- F12.250
- F12.251
- F12.259
- F12.280
- F12.288
- F12.29
- F13.10
- F13.120
- F13.121
- F13.129
- F13.130
- F13.131
- F13.132
- F13.139
- F13.14
- F13.150
- F13.151
- F13.159
- F13.180
- F13.181
- F13.182
- F13.188
- F13.19
- F13.20
- F13.220
- F13.221
- F13.229
- F13.230
- F13.231
- F13.232
- F13.239
- F13.24
- F13.250
- F13.251
- F13.259
- F13.26
- F13.27
- F13.280
- F13.281
- F13.282
- F13.288
- F13.29
- F14.10
- F14.120
- F14.121
- F14.122
- F14.129
- F14.13
- F14.14
- F14.150
- F14.151
- F14.159
- F14.180
- F14.181
- F14.182
- F14.188
- F14.19
- F14.20
- F14.220
- F14.221
- F14.222
- F14.229
- F14.23
- F14.24
- F14.250
- F14.251
- F14.259
- F14.280
- F14.281
- F14.282
- F14.288
- F14.29
- F15.10
- F15.120
- F15.121
- F15.122
- F15.129
- F15.13
- F15.14
- F15.150
- F15.151
- F15.159
- F15.180
- F15.181
- F15.182
- F15.188
- F15.19
- F15.20
- F15.220
- F15.221
- F15.222
- F15.229
- F15.23
SNOMED CT US Edition
- 281004
- 1383008
- 1686006
- 1973000
- 2403008
- 5002000
- 5444000
- 5602001
- 6348008
- 7052005
- 7071007
- 7200002
- 8635005
- 8837000
- 10028000
- 10327003
- 11387009
- 14784000
- 15167005
- 15277004
- 18653004
- 18689007
- 19445006
- 20385005
- 20876004
- 21647008
- 22574000
- 25753007
- 26714005
- 27956007
- 28864000
- 29212009
- 29733004
- 30491001
- 31956009
- 32009006
- 32358001
- 32875003
- 34938008
- 37344009
- 38247002
- 39807006
- 39951001
- 40571009
- 41083005
- 42344001
- 43497001
- 46975003
- 47664006
- 50320000
- 50933003
- 51443000
- 51493001
- 52866005
- 53050002
- 53936005
- 57588009
- 59651006
- 61104008
- 61144001
- 63649001
- 63983005
- 64386003
- 66590003
- 70328006
- 70340006
- 70701004
- 70932007
- 71328000
- 73097000
- 74851005
- 74934004
- 75122001
- 75544000
- 77355000
- 78267003
- 78358001
- 80868005
- 82339009
- 83367009
- 84758004
- 85005007
- 85561006
- 86325007
- 87132004
- 87810006
- 88926005
- 89451009
- 91388009
- 95661003
- 191475009
- 191476005
- 191478006
- 191480000
- 191802004
- 191804003
- 191805002
- 191811004
- 191812006
- 191819002
- 191820008
- 191825003
- 191826002
- 191831000
- 191832007
- 191837001
- 191838006
- 191843004
- 191844005
- 191849000
- 191850000
- 191853003
- 191855005
- 191856006
- 191865004
- 191867007
- 191868002
- 191877009
- 191882002
- 191883007
- 191891003
- 191893000
- 191894006
- 191899001
- 191900006
- 191905001
- 191906000
- 191909007
- 191912005
- 191913000
- 191916008
- 191918009
- 191919001
- 191924003
- 191925002
- 230443000
- 231461004
- 231462006
- 231468005
- 231469002
- 231470001
- 231472009
- 231473004
- 231474005
- 231475006
- 231477003
- 231478008
- 231479000
- 231480002
- 268640002
- 268645007
- 268646008
- 268647004
- 268648009
- 275471001
- 284591009
- 301643003
- 308742005
- 312098001
- 312936002
- 361150008
- 361151007
- 416714005
- 417143004
- 425339005
- 425885002
- 426001001
- 426095000
- 426873000
- 427205009
- 427229002
- 427327003
- 428370001
- 429692000
- 441527004
AOD Medication Treatment
HCPCS
- G2069
- G2070
- G2072
- G2073
- H0020
- H0033
- J0570
- J0571
- J0572
- J0573
- J0574
- J0575
- J2315
- Q9991
- Q9992
- S0109
SNOMED CT US Edition
- 310653000
Behavioral Health Assessment
CPT
- 99408
- 99409
HCPCS
- G0396
- G0397
- G0442
- G2011
- H0001
- H0002
- H0031
- H0049
SNOMED CT US Edition
- 40823001
- 49474007
- 58473000
- 64792006
- 89732002
- 171208001
- 314077000
- 370854007
- 391281002
- 410223002
- 410229003
- 414283008
- 414501008
- 415662004
- 439320000
- 703257008
- 713106006
- 713107002
- 713127001
- 713132000
- 713137006
- 428211000124100
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
Non-residential Substance Abuse Treatment Facility POS
POS
- 57
- 58
Observation
CPT
- 99217
- 99218
- 99219
- 99220
Online Assessments
CPT
- 99458
- 98969
- 98970
- 98971
- 98972
- 99421
- 99422
- 99423
- 99444
- 99457
HCPCS
- G0071
- G2010
- G2012
- G2061
- G2062
- G2063
- G2250
- G2251
- G2252
OUD Monthly Office Based Treatment
HCPCS
- G2086
- G2087
OUD Weekly Drug Treatment Service
HCPCS
- G2067
- G2068
- G2069
- G2070
- G2072
- G2073
OUD Weekly Non Drug Service
HCPCS
- G2071
- G2074
- G2075
- G2076
- G2077
- G2080
Outpatient POS
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
Partial Hospitalization POS
POS
- 52
Peer Support Services
HCPCS
- G0177
- H0024
- H0025
- H0038
- H0039
- H0040
- H0046
- H2014
- H2023
- S9445
- T1012
- T1016
Substance Induced Disorders
ICD10CM
- F10.920
- F10.921
- F10.929
- F10.930
- F10.931
- F10.932
- F10.939
- F10.94
- F10.950
- F10.951
- F10.959
- F10.96
- F10.97
- F10.980
- F10.981
- F10.982
- F10.988
- F10.99
- F11.90
- F11.920
- F11.921
- F11.922
- F11.929
- F11.93
- F11.94
- F11.950
- F11.951
- F11.959
- F11.981
- F11.982
- F11.988
- F11.99
- F12.90
- F12.920
- F12.921
- F12.922
- F12.929
- F12.93
- F12.950
- F12.951
- F12.959
- F12.980
- F12.988
- F12.99
- F13.90
- F13.920
- F13.921
- F13.929
- F13.930
- F13.931
- F13.932
- F13.939
- F13.94
- F13.950
- F13.951
- F13.959
- F13.96
- F13.97
- F13.980
- F13.981
- F13.982
- F13.988
- F13.99
- F14.90
- F14.920
- F14.921
- F14.922
- F14.929
- F14.93
- F14.94
- F14.950
- F14.951
- F14.959
- F14.980
- F14.981
- F14.982
- F14.988
- F14.99
- F15.90
- F15.920
- F15.921
- F15.922
- F15.929
- F15.93
- F15.94
- F15.950
- F15.951
- F15.959
- F15.980
- F15.981
- F15.982
- F15.988
- F15.99
- F16.90
- F16.920
- F16.921
- F16.929
- F16.94
- F16.950
- F16.951
- F16.959
- F16.980
- F16.983
- F16.988
- F16.99
- F18.90
- F18.920
- F18.921
- F18.929
- F18.94
- F18.950
- F18.951
- F18.959
- F18.97
- F18.980
- F18.988
- F18.99
- F19.90
- F19.920
- F19.921
- F19.922
- F19.929
- F19.930
- F19.931
- F19.932
- F19.939
- F19.94
- F19.950
- F19.951
- F19.959
- F19.96
- F19.97
- F19.980
- F19.981
- F19.982
- F19.988
- F19.99
SNOMED CT US Edition
- 281004
- 1383008
- 1686006
- 1973000
- 2403008
- 4863002
- 5444000
- 6348008
- 7052005
- 7200002
- 7916009
- 8635005
- 8837000
- 9953008
- 10327003
- 11061003
- 11387009
- 14784000
- 15167005
- 15277004
- 18653004
- 18689007
- 19303008
- 19445006
- 20385005
- 20876004
- 21007002
- 25702006
- 26714005
- 27956007
- 28368009
- 28864000
- 29212009
- 29733004
- 30491001
- 30871003
- 32009006
- 32358001
- 32552001
- 32875003
- 33871004
- 34938008
- 36558000
- 37331004
- 39003006
- 39807006
- 39951001
- 40571009
- 41083005
- 41309000
- 42344001
- 43497001
- 44047000
- 46721000
- 46975003
- 47664006
- 50026000
- 50320000
- 50325005
- 50722006
- 50933003
- 51443000
- 51493001
- 52866005
- 53050002
- 53936005
- 55967005
- 56194001
- 57588009
- 59651006
- 61104008
- 61144001
- 63649001
- 63983005
- 66590003
- 69482004
- 70328006
- 70655008
- 70932007
- 71328000
- 73097000
- 74934004
- 75122001
- 77355000
- 78358001
- 78524005
- 80868005
- 82047000
- 82339009
- 83168008
- 83367009
- 85561006
- 87132004
- 87810006
- 89451009
- 95635002
- 111480006
- 191471000
- 191475009
- 191476005
- 191478006
- 191480000
- 191802004
- 191804003
- 191805002
- 191806001
- 191811004
- 191812006
- 191813001
- 191882002
- 191883007
- 191884001
- 192811002
- 205788004
- 205791004
- 212807002
- 216633005
- 230353003
- 230443000
- 230800004
- 231467000
- 234341005
- 234366009
- 235875008
- 235880004
- 235881000
- 235942001
- 235952002
- 237641009
- 237738005
- 268645007
- 268796000
- 278363000
- 284591009
- 300992002
- 301643003
- 302507002
- 307757001
- 308692003
- 309279000
- 309783001
- 310202009
- 311173003
- 312098001
- 312936002
- 313915006
- 314539001
- 361268000
- 361272001
- 361273006
- 363314000
- 396344000
- 416073003
- 416714005
- 417143004
- 417360004
- 417633001
- 420054005
- 424199006
- 445507008
- 609437000
- 609438005
- 698321001
- 713181003
- 713370005
- 713583005
- 713862009
- 714829008
- 719848005
- 721710005
- 723103002
- 723882007
- 723926008
- 723927004
- 723928009
Substance Use Services
HCPCS
- H0006
- H0028
SNOMED CT US Edition
- 4266003
- 38670004
- 390857005
- 396150002
- 401266006
- 417096006
- 417699000
- 423416000
- 431260004
- 719757009
Substance Use Disorder Services
CPT
- 99408
- 99409
HCPCS
- G0396
- G0397
- G0443
- H0001
- H0005
- H0007
- H0015
- H0016
- H0022
- H0047
- H0050
- H2035
- H2036
- T1006
- T1012
SNOMED CT US Edition
- 20093000
- 23915005
- 56876005
- 61480009
- 64297001
- 67516001
- 87106005
- 182969009
- 266707007
- 310653000
- 370776007
- 370854007
- 385989002
- 386449006
- 386450006
- 386451005
- 414054004
- 414056002
- 414283008
- 414501008
- 415662004
- 424589009
- 445628007
- 445662007
- 450760003
- 704182008
- 707166002
- 711008001
- 713106006
- 713107002
- 713127001
- 720174008
- 720175009
- 720176005
- 720177001
- 763104007
- 763233002
- 763302001
- 772813001
- 774090004
- 774091000
- 792901003
- 792902005
- 827094004
- 865964007
- 428211000124100
UBREV
- 0906
- 0944
- 0945
Telehealth POS
POS
- 02
- 10
Telephone Visits
CPT
- 98966
- 98967
- 98968
- 99441
- 99442
- 99443
SNOMED CT US Edition
- 185317003
- 314849005
- 386472008
- 386473003
- 401267002
Unintentional Drug Overdose
ICD10CM
- T40.711A
- T40.711D
- T40.711S
- T40.714A
- T40.714D
- T40.714S
- T40.721A
- T40.721D
- T40.721S
- T40.724A
- T40.724D
- T40.724S
- T40.0X1A
- T40.0X1D
- T40.0X1S
- T40.0X4A
- T40.0X4D
- T40.0X4S
- T40.1X1A
- T40.1X1D
- T40.1X1S
- T40.1X4A
- T40.1X4D
- T40.1X4S
- T40.2X1A
- T40.2X1D
- T40.2X1S
- T40.2X4A
- T40.2X4D
- T40.2X4S
- T40.3X1A
- T40.3X1D
- T40.3X1S
- T40.3X4A
- T40.3X4D
- T40.3X4S
- T40.411A
- T40.411D
- T40.411S
- T40.414A
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SNOMED CT US Edition
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- 838520000
Visit Setting Unspecified
CPT
- 90791
- 90792
- 90832
- 90833
- 90834
- 90836
- 90837
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- 90839
- 90840
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