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 (Claims)
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
- T40.3X2A
- T40.3X2D
- T40.3X2S
- T40.412A
- T40.412D
- T40.412S
- T40.422A
- T40.422D
- T40.422S
- T40.492A
- T40.492D
- T40.492S
- T40.5X2A
- T40.5X2D
- T40.5X2S
- T40.602A
- T40.602D
- T40.602S
- T40.692A
- T40.692D
- T40.692S
- T40.722A
- T40.722D
- T40.722S
- 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
- F34.81
- 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
- F42.2
- 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
- F50.81
- 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
- 7052005
- 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
- 28864000
- 28884001
- 29599000
- 29733004
- 29929003
- 30059008
- 30077003
- 30336007
- 30491001
- 30509009
- 30520009
- 30605009
- 30687003
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
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
Telehealth POS
POS
- 02
- 10
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