Representing Stress

Type	Standard / Implementation Specification	Standards Process Maturity	Implementation Maturity	Federally required	Cost	Test Tool Availability
Standard	LOINC®	Final	Production	Yes	Free	N/A
Standard	SNOMED CT® U.S. Edition	Final	Production	No	Free	No
Standard	ICD-10-CM	Final	Production	No	Free	No
Standard	CPT®	Final	Production	No	$	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 a LOINC code for exchanging information about the level of stress a person is experiencing. This criterion was not changed in HTI-1. Stress is defined by the HL7 Gravity Project as occurring when a person perceives the demands of environmental stimuli to be greater than their ability to meet, mitigate, or alter those demands. The scope of the HL7 Gravity Project Stress domain is more broad than the certification criterion and includes information about related conditions and interventions. LOINC is used for Social Determinants of Health (SDOH) observations (assessment instrument panels, questions, and answers.) SNOMED CT U.S. Edition is used for SDOH observations, conditions, goals, and interventions. ICD-10-CM is used for SDOH diagnoses. CPT is used for SDOH procedures and interventions. Implementation information for Stress exchange can be found in Structure and Exchange of Social Determinants of Health Information. For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.	Stress Screening Assessments (LOINC) Stress Screening Assessments Questions (LOINC) Stress Screening Assessments Answers (LOINC) Stress Diagnoses (ICD-10-CM, SNOMED CT) Stress Goals (SNOMED CT) Stress Procedures (CPT, SNOMED CT) Stress Service Requests (CPT, SNOMED CT) 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 a LOINC code for exchanging information about the level of stress a person is experiencing. This criterion was not changed in HTI-1.
Stress is defined by the HL7 Gravity Project as occurring when a person perceives the demands of environmental stimuli to be greater than their ability to meet, mitigate, or alter those demands.
The scope of the HL7 Gravity Project Stress domain is more broad than the certification criterion and includes information about related conditions and interventions.
LOINC is used for Social Determinants of Health (SDOH) observations (assessment instrument panels, questions, and answers.)
SNOMED CT U.S. Edition is used for SDOH observations, conditions, goals, and interventions.
ICD-10-CM is used for SDOH diagnoses.
CPT is used for SDOH procedures and interventions.
Implementation information for Stress exchange can be found in Structure and Exchange of Social Determinants of Health Information.
For more information about observations and observation values, see Appendix III for an informational resource developed by the Health IT Standards Committee.

Stress Screening Assessments (LOINC)
Stress Screening Assessments Questions (LOINC)
Stress Screening Assessments Answers (LOINC)
Stress Diagnoses (ICD-10-CM, SNOMED CT)
Stress Goals (SNOMED CT)
Stress Procedures (CPT, SNOMED CT)
Stress Service Requests (CPT, SNOMED CT)
HTI-1 Requirements

Comment

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 Stress. The CPT codes 90839 and 90840 are used to identify psychotherapy for a crisis. Also, the CPT Evaluation and Maintenance services include assessing a patient’s level of stress.

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 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.

Submitted by gdixon on 2018-09-12

LOINC cited is insufficient

76542-0 is stated to be Occupational Stress Questionnaire. Stress has multiple causes, Occupational, Personal, etc. This needs exploration and better difinition

76542-0

Do you feel stress - tense, restless, nervous, or anxious, or unable to sleep at night because your mind is troubled all the time - these days [OSQ]

supplemental LONIC suggestion

66578-6

Now thinking about your mental health, which includes stress, depression, and problems with emotions, for how many days during the past 30 days was your mental health not good [HRQOL]

Submitted by cmcdonald on 2018-10-01

This is the specific one…

This is the specific one chosen (from a Finnish survey instrument by the IOM report and required by ONC), it is what is in there.