Posttraumatic Stress Disorder (PTSD) Outcome Assessment for Adults and Children
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.
- 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)
Patients self-reported symptoms for a duration of at least one month (adults patients) or two weeks (child patients) following a traumatic event indicated by:
Diagnosis for PTSD:
F43.10 PTSD, Unspecified
F43.11 PTSD, Acute
F43.12 PTSD, Chronic
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
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.
The number of 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.
- 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.
- For children and adolescents, age 7-17, a CATS score decrease of 12 or more in the total score OR a score <15 on the follow-up administration.
- Patients who die OR
• Are enrolled in hospice in the measurement year (PRO2007.1Y1) 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 (PRO2007.1Y3)
Denominator Exceptions (PRO2007.4Ex )
- 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)
Effective Clinical Care
High Priority Type
Patient Reported Outcome (PRO)
Meaningful Measure Area
Prevention, Treatment, and Management of Mental Health
Continuous Variable Measure
Number of performance rates to be submitted
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