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