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COVID-19

Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC)

HEDIS Measure

Follow-Up After Emergency Department Visit for People With Multiple High-Risk Chronic Conditions (FMC)

Line of business: Medicare

Data Collection Method: Administrative (Claims)

Measure Description

The percentage of emergency department (ED) visits for members 18 years of age and older who have multiple high-risk chronic conditions who had a follow-up service within 7 days of the ED visit.

Numerator Compliance

A follow-up service within 7 days after the ED visit (8 total days).

Include visits that occur on the date of the ED visit. The following meet criteria for follow-up:

  • An outpatient visit
  • A telephone visit
  • Transitional care management services
  • Case management visits
  • Complex Care Management Services
  • An outpatient or telehealth behavioral health visit with Outpatient POS
  • An outpatient or telehealth behavioral health visit
  • An intensive outpatient encounter or partial hospitalization with Partial Hospitalization
  • An intensive outpatient encounter or partial hospitalization
  • A community mental health center visit with Community Mental Health Center POS
  • Electroconvulsive therapy with Ambulatory Surgical Center, Community Mental Health Center POS, Outpatient POS or Partial Hospitalization POS
  • A telehealth visit with Telehealth POS
  • An observation visit
  • A substance use disorder service
  • An e-visit or virtual check-in
  • A domiciliary or rest home visit

Best Practices

  • Educate the patient about the importance of follow-up and adherence to treatment recommendations
  • Discuss the importance of timely, recommended follow-up visits
  • Schedule follow-up appointments as soon as possible, particularly those patients recently discharged
  • 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
  • Consider telemedicine visit when in-person visits are not available
  • Discuss the importance of seeking follow-up with a mental health provider
  • Develop outreach internal team and/or assign care/case managers to members to ensure members keep follow-up appointments or reschedule missed appointments
  • Set flags if available in EHR or develop tracking method for patients who may need screenings and follow-up visits

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

Case Management Encounter

CPT

  • 99366

HCPCS

  • T1016
  • T1017
  • T2022
  • T2023

SNOMED CT US Edition

  • 386230005
  • 416341003
  • 425604002

Community Mental Health Center POS

POS

  • 53

Complex Care Management Services

CPT

  • 99439
  • 99487
  • 99489
  • 99490
  • 99491

HCPCS

  • G0506

Domiciliary or Rest Home Visit

CPT

  • 99324
  • 99325
  • 99326
  • 99327
  • 99328
  • 99334
  • 99335
  • 99336
  • 99337

Electroconvulsive Therapy

CPT

  • 90870

ICD10PCS

  • GZB0ZZZ
  • GZB1ZZZ
  • GZB2ZZZ
  • GZB3ZZZ
  • GZB4ZZZ

SNOMED CT US Edition

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

Observation

CPT

  • 99217
  • 99218
  • 99219
  • 99220

Online Assessments

CPT

  • 98969
  • 98970
  • 98971
  • 98972
  • 99421
  • 99422
  • 99423
  • 99444
  • 99457
  • 99458

HCPCS

  • G0071
  • G2010
  • G2012
  • G2061
  • G2062
  • G2063
  • G2250
  • G2251
  • G2252

Outpatient

CPT

  • 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
  • 99429
  • 99455
  • 99456
  • 99483

HCPCS

  • G0402
  • G0438
  • G0439
  • G0463
  • T1015

SNOMED CT US Edition

  • 30346009
  • 37894004
  • 77406008
  • 84251009
  • 185463005
  • 185464004
  • 185465003
  • 281036007
  • 439740005
  • 3391000175108
  • 444971000124105

UBREV

  • 0510
  • 0511
  • 0512
  • 0513
  • 0514
  • 0515
  • 0516
  • 0517
  • 0519
  • 0520
  • 0521
  • 0522
  • 0523
  • 0526
  • 0527
  • 0528
  • 0529
  • 0982
  • 0983

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

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

Transitional Care Management Services

CPT

  • 99495
  • 99496

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