2023 # MBHR07 Posttraumatic Stress Disorder (PTSD) Outcome Assessment for Adults and Children

Measure Title: Posttraumatic Stress Disorder (PTSD) Outcome Assessment for Adults and Children

Description: The percentage of patients with a history of a traumatic event (i.e., an experience that was unusually or especially frightening, horrible, or traumatic) who report symptoms consistent with PTSD for at least one month following the traumatic event AND with documentation of a standardized symptom monitor (PCL-5 for adults, CATS for child/adolescent) AND demonstrated a response to treatment at six months (+/- 120 days) after the index visit.

This measure is a multi-strata measure, which addresses symptom monitoring for both child and adult patients being treated for post-traumatic stress symptoms. Assessment instruments monitoring severity of symptoms for PTSD are validated either for adult or child populations. Thus, while the measurement structure will be similar for both populations, the specified instruments for symptom monitoring will be different.

To see additional details, please view the workflow diagram for this measure: View diagram

This measure relies on the PCL-5 (for adults) or CATS (for youth) assessment tools, which can be found here and here respectively.

Denominator: 

Denominator (Submission Criteria): 

1. Adult patients (18 years of age or older) with one of the PTSD related diagnoses (see Diagnostic list)

2. Child/adolescent patients (7-17 years of age) with one of the PTSD related diagnoses (see Diagnostic list)

 Denominator Criteria (Eligible cases):

Patients (identified as either in the adult category–aged 18 of age or older OR child category–aged 7-17)

AND

Patients self-reported symptoms for a duration of at least one month (adults patients) or two weeks (child patients) following a traumatic events indicated by

Diagnosis for PTSD:

F43.10 PTSD, Unspecified

F43.11 PTSD, Acute

F43.12 PTSD, Chronic

AND

Patient encounter during the denominator identification period (CPT or HCPCS):

0362T, 0373T, 90785, 90791, 90792, 90832,90833, 90834, 90836, 90837, 90838, 90839, 90840, 90845, 90846, 90847, 90849, 90853, 90863, 90875, 90876, 96110, 96112, 96113, 96116, 96121, 96127, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139, 96146, 96156, 96158, 96159, 96164, 96165, 96167, 96170, 96171, 96178, 97129, 97130, 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 98966, 98967, 98968, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215,99354, 99355, 99406, 99407, 99408, 99409, 99446, 99447, 99448, 99449, 99484, 99492, 99493, 99494, G2011, G2061, G2062, G2063, G0396, G0397, G0402, G0438, G0439  

AND
An Index Visit where the PTSD symptom assessment was completed with a PCL-5 score of 33 or more for an adult patient OR self-reported CATS 7-17 score of 15 or more for a child/adolescent patient.

Denominator Identification Period – The period in which eligible patients can have an index event. The denominator identification period is from 1/1/2023 to 12/31/2023.

Index Event Date: The date on which the validated PTSD symptom monitor (e.g. PCL-5 for adult; CATS 7-17 for child) first score documented during the twelve month denominator identification period to the measurement period and

Measure Assessment Period: For patients with an index event, there needs to be enough time for patients to have the opportunity to reach response to treatment status.  This is defined as 6 months (+/- 120 days) after the index event date

Numerator: 

Definitions:

Response to Treatment: Patients in the denominator who demonstrated a response to treatment, using the identified validated PTSD self-report symptom monitor for the patient’s age group with a demonstrated change score indicating improvement.

1. For adults (age 18 and older), the instrument is the PCL-5, and a score reflecting symptom improvement is decrease of 5 or more on the total score from baseline administration.

2. For children and adolescents, age 7-17, a CATS, score decrease of 12 or more in the total score OR a score of 15 on the follow-up administration.

Six Months: The point in time 6 months (+/- 120days) from the index event date. The most advantageous  PCL-5/CATS 7-17 score during this 6 month period is used to determine the patient’s response to treatment.

Denominator Exclusions: 

• Patients who die OR

• Are enrolled in hospice in the measurement year OR

• Are unable to complete the required assessment measure at follow-up due to cognitive deficit, visual deficit, motor deficit, language barrier, or low reading level, AND a suitable recorder (e.g., advocate) is not available

Denominator Exceptions: 

• Ongoing care not indicated (e.g., referred to another provider or facility, consultation only) OR

• Patient self-discharged early (e.g., financial or insurance reasons, transportation problems, or reason unknown) OR

• Medical reasons (e.g., scheduled for surgery or hospitalized)

National Quality Forum (NQF) number, if applicable
N/A

Care setting(s) 
Ambulatory Care: Clinician Office/Clinic; Ambulatory Care: Hospital; Hospital; Hospital Inpatient; Hospital Outpatient; Long Term Care; Nursing Home; Outpatient Services; Rehabilitation Facility; Rehabilitation Facility: Inpatient

Telehealth, if applicable
Yes

Number of performance rates required for measures
1

Traditional vs. inverse measure
Traditional

Proportional, continuous variable, and/or ratio measure indicator
Proportional

Risk adjustment, if applicable
No

Submission pathway 
Traditional MIPS