Representing Depression

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Adoption Level	Federally required	Cost	Test Tool Availability
Standard	LOINC®	Final	Production		Yes	Free	N/A
Standard for observation values	Unified Code for Units of Measure	Final	Production		Yes	Free	N/A

Limitations, Dependencies, and Preconditions for Consideration	Applicable Value Set(s) and Starter Set(s)
The optional 2015 Edition Cures Act Social, psychological, and behavioral data criterion (170.315(a)(15)) specifies LOINC codes for exchanging depression observations. This criterion was not changed in HTI-1. The Patient Health Questionnaire 2 item (PHQ-2) is a two-question screening tool for symptoms of depression in the past two weeks. It consists of the first two questions of the PHQ-9. The full Patient Health Questionnaire 9 item (PHQ-9) incorporates DSM-IV depression criteria with other major depressive symptoms into a brief self-report instrument commonly used for screening and diagnosis, as well as selecting and monitoring treatment. The HL7® Post Acute Care Interoperability (PACIO) project provides additional information about the depression screening panels. The Beck Depression Inventory Fast Screen (BDI FS) is a shorter version of the Beck Depression Inventory II (BDI II). The BDI FS contains seven items from the BDI II and is used to evaluate depression symptoms in alignment with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for depression. [PMID:19010075] Units of measure for quantitative result values must be represented using UCUM, see Representing Units of Measure. For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.	Patient Health Questionnaire 2 (PHQ-2): LOINC 55757-9 PHQ-9 Quick Depression Assessment Panel: LOINC 44249-1 Patient Health Questionnaire - Somatic, Anxiety, and Active Depressive Symptoms: LOINC 69729-2 Beck Depression Inventory Fast Screen [BDI]: LOINC 89211-7 Beck Depression Inventory: LOINC 89210-9 Resident mood interview (PHQ-9:) LOINC 54635-8 HTI-1 Requirements

Limitations, Dependencies, and Preconditions for Consideration

Applicable Value Set(s) and Starter Set(s)

The optional 2015 Edition Cures Act Social, psychological, and behavioral data criterion (170.315(a)(15)) specifies LOINC codes for exchanging depression observations. This criterion was not changed in HTI-1.
The Patient Health Questionnaire 2 item (PHQ-2) is a two-question screening tool for symptoms of depression in the past two weeks. It consists of the first two questions of the PHQ-9.
The full Patient Health Questionnaire 9 item (PHQ-9) incorporates DSM-IV depression criteria with other major depressive symptoms into a brief self-report instrument commonly used for screening and diagnosis, as well as selecting and monitoring treatment.
The HL7® Post Acute Care Interoperability (PACIO) project provides additional information about the depression screening panels.
The Beck Depression Inventory Fast Screen (BDI FS) is a shorter version of the Beck Depression Inventory II (BDI II). The BDI FS contains seven items from the BDI II and is used to evaluate depression symptoms in alignment with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for depression. [PMID:19010075]
Units of measure for quantitative result values must be represented using UCUM, see Representing Units of Measure.
For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.

Patient Health Questionnaire 2 (PHQ-2): LOINC 55757-9
PHQ-9 Quick Depression Assessment Panel: LOINC 44249-1
Patient Health Questionnaire - Somatic, Anxiety, and Active Depressive Symptoms: LOINC 69729-2
Beck Depression Inventory Fast Screen [BDI]: LOINC 89211-7
Beck Depression Inventory: LOINC 89210-9
Resident mood interview (PHQ-9:) LOINC 54635-8
HTI-1 Requirements

Comment

Submitted by mattreid on 2021-09-30

The AMA requests that the…

The AMA requests that the Current Procedural Terminology (CPT) code set be added to the standards listed in Section I: Representing Depression. CPT code 96127 specifically identifies the screening of a patient within a behavioral assessment for depression. CPT code 99483 includes an assessment for depression within the cognitive care plan.

These identified CPT codes were designed based on objective criteria for evaluating and assessing the severity and co-morbidities associated with the assessment and treatment of depression that should be listed as a standard for this interoperability need.

CPT is a comprehensive and regularly curated uniform language that accurately describes medical, surgical, and diagnostic services and provides for reliable communication among users. It has an extremely robust and mature development process with open and transparent meetings and clinical input from national medical specialties and relevant stakeholders. It is the most widely adopted outpatient procedure code set. Use of the CPT code set is federally required under HIPAA.

Submitted by mattreid on 2020-03-26

The AMA requests that the…

The AMA requests that the Current Procedural Terminology (CPT) code set be added to the standards listed in Section I: Representing Depression. CPT code 96127 identifies patient screening through a behavioral assessment for depression. CPT code 99483 includes an assessment for depression within the cognitive care plan. CPT code 96127 includes an assessment for depression with this developmental/behavioral screening and testing.

In addition, CPT Category II code 1040F, 2060F, and 3088F – 3093F identify evaluations of major depressive disorder. CPT Category II codes 1220F, 3351F – 3354F, 3725F identify a patient screened for depression within the treatment of other clinical conditions. CPT Category II codes 4060F – 4067F identify various services provided depression.

Submitted by mattreid on 2019-09-23

General comment on social, psychological, and behavioral data

The American Medical Association appreciates the opportunity to comment. Coding systems like SNOMED CT are designed to capture granular clinical data accurately. While it is possible to convert granular clinical data to ICD-10-CM (e.g., SNOMED CT -> ICD-10-CM), the reverse (e.g., ICD-10-CM -> SNOMED CT) is not reliable.

Where ICD-10-CM may be the best choice to meet specific needs (e.g., public health reporting or administrative forms for payors), there are means whereby ICD-10-CM codes can be computed from the more specific clinical data provided by code systems like SNOMED CT.

For these reasons, where there are established (legacy) code systems, we should continue to support them. However, where possible, we should also consider the graceful evolution to codings systems (e.g., SNOMED CT) that more accurately support granular clinical data.

Submitted by cmcdonald on 2018-10-01

Since this LOINC code and…

Since this LOINC code and answer set has been developed (30 behavior and functional status variables suggested by the IOM report and adopted for requirement in the last MU NPRM), the adoption level could now be very high.