GenIC #48 (Extension w/o change): Section 223 Demonstration Programs to Improve Community Mental Health Services

Metrics and Quality
Measures for Behavioral
Health Clinics
Technical Specifications
and Resource Manual

(Volume 2)
April 2016

1

Contents
Contents .................................................................................................................................................. 2
GENERAL APPENDICES ...................................................................................................................... 4
Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics and
Quality Measures .............................................................................................................................. 5
Appendix B. BHC Value Set Directory User Manual .......................................................................... 16
Appendix C. Guidance for Selecting Sample Sizes for HEDIS® Hybrid Measures ............................... 21
Appendix D. Definitions of Practitioner Types ................................................................................. 23
APPENDICES FOR SPECIFIC MEASURES ....................................................................................... 25
Appendix ROUT: Routine Care Needs .............................................................................................. 26
Appendix I-EVAL: Time to Initial Evaluation ..................................................................................... 28
Appendix TX-EVAL: Time to Comprehensive Person and Family-Centered Diagnostic and Treatment
Planning Evaluation ......................................................................................................................... 33
Appendix SUIC: Deaths by Suicide ................................................................................................... 36
Appendix DOC.A: Documentation of Current Medications in the Medical Record ............................ 37
Appendix DOC.B: Documentation of Current Medications in the Medical Record ............................ 40
Appendix BMI-SF.A: Preventive Care & Screening: Body Mass Index (BMI) Screening & Follow-Up .. 41
Appendix BMI-SF.B. Codes Relevant to Preventive Care & Screening: Adult Body Mass Index (BMI)
Screening and Follow-Up................................................................................................................. 44
Appendix CBP-BH. Controlling High Blood Pressure ......................................................................... 45
Appendix TSC.A: Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention ... 47
Appendix TSC.B: Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention ... 50
Appendix ASC.A: Preventive Care & Screening: Unhealthy Alcohol Use: Screening & Brief Counseling
....................................................................................................................................................... 51
Appendix ASC.B: Preventive Care & Screening: Unhealthy Alcohol Use: Screening & Brief Counseling
....................................................................................................................................................... 54
Appendix SRA-BH-C: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-BH-C) Measure... 55
Appendix SRA-A.A: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-A) Measure .......... 62
Appendix SRA-A.B: Major Depressive Disorder (MDD): Suicide Risk Assessment .............................. 67
Appendix SRA-A.C: Major Depressive Disorder (MDD): Suicide Risk Assessment .............................. 68
Appendix CDF-BH.A: Screening for Clinical Depression and Follow-Up Plan ..................................... 71
Appendix CDF-BH.B: Screening for Clinical Depression and Follow-Up Plan..................................... 75
Appendix DEP-REM-12. Depression Remission at Twelve Months ................................................... 76
Appendix HOU: Housing Status ....................................................................................................... 79
2

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts................................... 80
Appendix PCR-BH: Plan All-Cause Readmissions Rate .................................................................... 134
Appendix AMS-BD: Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder ............ 136
Appendix SAA-BH: Adherence to Antipsychotics for Individuals with Schizophrenia...................... 140
Appendix ADD-BH: Follow-Up Care for Children Prescribed Attention-Deficit Hyperactivity Disorder
(ADHD) Medication ....................................................................................................................... 142
Appendix AMM-BH: Antidepressant Medication Management...................................................... 143

3

GENERAL APPENDICES

4

Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics and Quality Measures

Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics
and Quality Measures
The following tables provide the measurement periods for denominators and numerators as well as the continuous enrollment
period, where applicable. For the sake of simplicity, examples of measurement periods and measurement years are provided that
rely on the calendar year. For CCBHCs, however, the measurement year (and the measurement period) will vary, depending on
the demonstration start date, although the measurement year will always be a full 12 month period. For example, a CCBHC
measurement year beginning on March 1, 2017 will end on February 28, 2018 and measurement periods will be in relation to that
measurement year. To ascertain measurement periods that correspond to potential CCBHC measurement years, please see the last
worksheet in the data-reporting templates.
Table A1. Clinic-Reported Measures – Measurement Period 1
Measure

Denominator2

Numerator

Routine Care Needs
(ROUT) (cont’d)

The measurement year and
the 6 months before (e.g.,

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,

Continuous Enrollment
Period3
NA

1

For some measures, the measurement period for the numerator, denominator, or continuous enrollment period varies depending on a specified date for each
consumer (such as consumer birthdates, prescription or treatment start dates, and discharge dates). The measurement period defined in these tables identifies the
full range of possible dates that will be used to calculate the measure for all measure-eligible consumers. Refer to the specification for additional details.
2

When reporting each measure, states and BHC providers should report the measurement period they used for the denominator (and the numerator) in the
applicable “Start Date” and “End Date” fields in Section B of the data-reporting template. Some measures also require states and BHC providers to review
utilization or enrollment prior to this period to identify the measure-eligible population. For these measures, two date ranges are included in this table. The first
date range should be used to populate the Start Date and End Date fields, while the second date range defines these prior review periods and should not be
included in the Start Date and End Date fields. For example, the AMM-BH measure instructs states to identify enrollees with antidepressant prescriptions that
started May 1, 2016 – April 30, 2017 (the first date range). However, states will also need to review enrollee medication history for 105 days prior to the start of
the index prescription (the second date range). States and BHC providers should enter “May 1, 2016” in the Start Date field and “April 30, 2017” in the End Date
field. States should note any deviations to any measurement period (numerator, denominator, continuous enrollment) in Section E (Adherence to Measure
Specifications) of the data-reporting template.
3

Refer to the measure specification for information on allowable gaps in the continuous enrollment period.

5

Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics and Quality Measures

Measure

Denominator2

Numerator

Routine Care Needs
(ROUT) (cont’d)

July 1, 2016 – Dec. 31,
2017)

2017)

Time to Initial Evaluation (IEVAL)

The measurement year
The measurement year (e.g.,
excluding the last 30 days of Jan. 1, 2017 – Dec. 31,
the measurement year and
2017)
including the 6 months
before (e.g., July 1, 2016 Dec. 1, 2017)

NA

Time to Comprehensive
Person and Family-Centered
Diagnostic and Treatment
Planning Evaluation (TXEVAL)

The measurement year
The measurement year (e.g.,
excluding the last 90 days of Jan. 1, 2017 – Dec. 31,
the measurement year and
2017)
including the 6 months
before (e.g., July 1, 2016 –
Oct. 2, 2017)

NA

Deaths by Suicide (SUIC)

The measurement year
The measurement year (e.g.,
(e.g., Jan. 1, 2017 – Dec. 31, Jan. 1, 2017 – Dec. 31,
2017)
2017)

NA

Documentation of Current
Medications in the Medical
Record (DOC)

The measurement year
The measurement year (e.g.,
(e.g., Jan. 1, 2017 – Dec. 31, Jan. 1, 2017 – Dec. 31,
2017)
2017)

NA

Preventive Care &
Screening: Adult Body Mass
Index (BMI) Screening &
Follow-Up (BMI-SF)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

NA

The measurement year and
the previous 6 months (e.g.,
Jul. 1, 2016 – Dec. 31,
2017)

Continuous Enrollment
Period3

6

Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics and Quality Measures

Measure

Denominator2

Numerator

Body Mass Index
Assessment for
Children/Adolescents
(WCC-BH)

The measurement year

The measurement year

Controlling High Blood
Pressure (Adult) (CBP-BH)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

Continuous Enrollment
Period3
The measurement year

(e.g., Jan. 1, 2017 – Dec. 31, (e.g., Jan. 1, 2017 – Dec. 31,
2017)
2017)
The measurement year 4
The measurement year
(e.g., Jan. 1, 2017 – Dec. 31,
2017)

Hypertension diagnosis:
Confirm anytime during the
enrollee’s history during or
before the first 6 months of
the measurement year

4

Preventive Care &
Screening: Tobacco Use:
Screening & Cessation
Intervention (TSC)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

The measurement year and
the prior year (e.g., Jan. 1,
2016 – Dec. 31, 2017)

NA

Preventive Care &
Screening: Unhealthy
Alcohol Use: Screening &
Brief Counseling (ASC)

The measurement year

The measurement year and
the prior year (e.g., Jan. 1,
(e.g., Jan. 1, 2017 – Dec. 31,
2016 – Dec. 31, 2017)
2017)

NA

Blood pressure reading must occur after the diagnosis of hypertension was made.

7

Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics and Quality Measures

Measure
Child and Adolescent Major
Depressive Disorder: Suicide
Risk Assessment (SRA-BHC)

Denominator2

Numerator

Continuous Enrollment
Period3
The measurement year (e.g., The measurement year (e.g., NA
Jan. 1, 2017 – Dec. 31,
Jan. 1, 2017 – Dec. 31,
2017)
2017)

Adult Major Depressive
Disorder (MDD): Suicide
Risk Assessment (SRA-A)

The measurement year (e.g., The measurement year (e.g., NA
Jan. 1, 2017 – Dec. 31,
Jan. 1, 2017 – Dec. 31,
2017)
2017)

Screening for Clinical
Depression and Follow-Up
Plan (CDF-BH)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

NA

Depression Remission at
Twelve Months (DEPREM-12)

The measurement year,
starting for each person’s
individual index date (e.g.,
Jan. 1, 2017 – Dec. 31, 2017
for index date Jan. 1, 2017)

Begins on the index date for
the individual during the
measurement year and ends
at the point 12 months and
30 days later) (e.g., for
index date Jan. 1, 2017, Jan.
1, 2017 – Jan. 30, 2018)

NA

8

Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics and Quality Measures

Table A2. State-Reported Measures – Measurement Period5
Measure

Denominator6

Numerator

Housing Status (HOU)

The measurement year,
divided into 2 equal parts
(e.g., Jan. 1, 2017 – Jun. 30,
2017 and Jul. 1, 2017 – Dec.
31, 2017)

The measurement year,
divided into 2 equal parts
(e.g., Jan. 1, 2017 – Jun. 30,
2017 and Jul. 1, 2017 – Dec.
31, 2017)

Suicide Attempts (SU-A)

The first 11 months of the
measurement year (e.g., Jan.
1, 2017 – Nov. 30, 2017)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

The measurement year

Patient Experience of Care
Survey (PEC)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

NA

Continuous Enrollment
Period7
NA

5

For some measures, the measurement period for the numerator, denominator, or continuous enrollment period varies depending on a specified date for each
consumer (such as consumer birthdates, prescription or treatment start dates, and discharge dates). The measurement period defined in these tables identifies the
full range of possible dates that will be used to calculate the measure for all measure-eligible consumers. Refer to the specification for additional details.
6

When reporting each measure, states and BHC providers should report the measurement period they used for the denominator (and the numerator) in the
applicable “Start Date” and “End Date” fields in Section B of the data-reporting template. Some measures also require states and BHC providers to review
utilization or enrollment prior to this period to identify the measure-eligible population. For these measures, two date ranges are included in this table. The first
date range should be used to populate the Start Date and End Date fields, while the second date range defines these prior review periods and should not be
included in the Start Date and End Date fields. For example, the AMM-BH measure instructs states to identify enrollees with antidepressant prescriptions that
started May 1, 2016 – April 30, 2017 (the first date range). However, states will also need to review enrollee medication history for 105 days prior to the start of
the index prescription (the second date range). States and BHC providers should enter “May 1, 2016” in the Start Date field and “April 30, 2017” in the End Date
field. States should note any deviations to any measurement period (numerator, denominator, continuous enrollment) in Section E (Adherence to Measure
Specifications) of the data-reporting template.
7

Refer to the measure specification for information on allowable gaps in the continuous enrollment period.

9

Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics and Quality Measures

Measure

Denominator6

Numerator

Youth/Family Experience of
Care Survey (Y/FEC)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

Follow-Up After Emergency
Department Visit for Mental
Illness (FUM)

The measurement year less
The measurement year
Date of emergency
the last 30 days of the
(e.g., Jan. 1, 2017 – Dec. 31, department visit through 30
measurement year (e.g., Jan. 2017)
days after the ED visit
1, 2017 – Dec. 1, 2017)

Follow-Up After Emergency
Department Visit for Alcohol
and Other Drug Dependence
(FUA)

The measurement year less
The measurement year (e.g.,
the last 30 days of the
Jan. 1, 2017 – Dec. 31,
measurement year (e.g., Jan. 2017)
1, 2017 – Dec. 1, 2017)

Date of emergency
department visit through 30
days after the ED visit

Plan All-Cause
Readmissions Rate (PCRBH)

The measurement year,
measured from the
discharge date, less the last
30 days of the measurement
year (e.g., Jan. 1, 2017 –
Dec. 1, 2017)

The measurement year (30
days following IHS
discharge date) (e.g., Jan. 1,
2017 – Dec. 31, 2017)

365 days prior to the Index
Discharge Date through 30
days after the Index Discharge
Date (e.g., (365 days prior to
IHS discharge date through 30
days after the IHS discharge
date)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

The measurement year

Diabetes Screening for
The measurement year and
People with Schizophrenia or the prior year (e.g., Jan. 1,
Bipolar Disorder Who Are
2016 – Dec. 31, 2017)
Using Antipsychotic
Medications (SSD)

Continuous Enrollment
Period7
NA

10

Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics and Quality Measures

Measure

Denominator

Numerator

Diabetes Care For People
With Serious Mental Illness:
Hemoglobin A1c (HbA1c)
Poor Control (>9.0%) (SMIPC)

The measurement year and
the prior year (e.g., Jan. 1,
2016 – Dec. 31, 2017)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

Metabolic Monitoring for
Children and Adolescents on
Antipsychotics (APM)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

The measurement year (e.g., The measurement year
Jan. 1, 2017 – Dec. 31,
2017)

Cardiovascular Monitoring
For People With
Cardiovascular Disease and
Schizophrenia (SMC)

The measurement year and
the prior year (e.g., Jan. 1,
2016 – Dec. 31, 2017)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

The measurement year and
the prior year

Adherence to Mood
Stabilizers for Individuals
with Bipolar I Disorder
(AMS-BD)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

The measurement year (e.g.,
Jan. 1, 2017 – Dec. 31,
2017)

The measurement year

Adherence to Antipsychotics
for Individuals with
Schizophrenia (SAA-BH)

Index prescription start date IPSD during the
(IPSD) during the
measurement year (e.g., Jan.
measurement year (e.g., Jan. 1, 2017 – Dec. 31, 2017)
1, 2017 – Dec. 31, 2017)

The measurement year

Adult Follow-Up After
The measurement year
Hospitalization for Mental
measured from the
Illness (FUH-BH-A) (cont’d) discharge date, less the last
30 days of the measurement

7 day follow-up: The
measurement year measured
from the discharge date
through 7 days after the

Continuous Enrollment
Period
The measurement year and
the prior year

The measurement year
(discharge date through 30
days after discharge date)

11

Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics and Quality Measures

Measure

Denominator

Adult Follow-Up After
year (e.g., Jan. 1, 2017 –
Hospitalization for Mental
Dec. 1, 2017)
Illness (FUH-BH-A) (cont’d)

Numerator

Continuous Enrollment
Period

discharge date (e.g.,
January 1, 2017 – December
8, 2017)
30 day follow-up: The
measurement year measured
from the discharge date
through 30 days after
discharge date (e.g., Jan. 1,
2017 – Dec. 31, 2017)

Child Follow-Up After
Hospitalization for Mental
Illness (FUH-BH-C)

The measurement year
measured from the
discharge date, less the last
30 days of the measurement
year (e.g., Jan. 1, 2017 –
Dec. 1, 2017)

7 day follow-up: The
The measurement year
measurement year measured (discharge date through 30
from the discharge date
days after discharge date)
through 7 days after the
discharge date (e.g.,
January 1, 2017 – December
8, 2017)
30 day follow-up: The
measurement year measured
from the discharge date
through 30 days after
discharge date (e.g., Jan. 1,
2017 – Dec. 31, 2017)

12

Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics and Quality Measures

Measure

Denominator

Numerator

Follow-Up Care for Children
Prescribed Attention-Deficit/
Hyperactivity Disorder
(ADHD) Medication (ADDBH)

For the denominator, two
measurement periods are
used:

For the numerator, two
measurement periods are
used:

Index prescription start date
(IPSD): 10 months before
the measurement year
begins to 2 months after the
measurement year begins
(e.g., March 1, 2016 –
February 28, 2017)

Initiation Phase: The time
period between 30 days
after the IPSD measurement
period begins and 30 days
after the IPSD measurement
period ends (e.g., March 31,
2016 – March 30, 2017)

Negative medication history
review: The time period
between 120 days before the
IPSD measurement period
begins and 120 days before
the IPSD measurement
period ends (e.g., November
2, 2015 – October 31, 2016)

Continuation and
Maintenance Phase: The
time period between 300
days after the IPSD
measurement period begins
and 300 days after the IPSD
measurement period ends
(e.g., December 26, 2016 –
December 25, 2017)

For the denominator, two
measurement periods are
used:

For the numerator, two
measurement periods are
used:

105 days (3 months) prior to
the IPSD through 231 days
after the IPSD

Index prescription start date
(IPSD): The time period

Acute Phase: The time
period between 114 days

(e.g., Jan. 16, 2016 – Dec. 17,
2017)

Antidepressant Medication
Management (AMM-BH)
(cont’d)

Continuous Enrollment
Period
Initiation Phase: 120 days (4
months) prior to the IPSD
through 30 days (1 month)
after the IPSD
(e.g., November 1, 2015 –
March 30, 2017)
Continuation Phase: 120 days
prior to IPSD through 300
days after the IPSD
(e.g., November 1, 2015 –
December 25, 2017

13

Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics and Quality Measures

Measure

Denominator

Numerator

Antidepressant Medication
Management (AMM-BH)
(cont’d)

between 7 months before
the measurement year
begins and 4 months after
the measurement year
begins (e.g., June 1, 2016 –
April 30, 2017)

after the IPSD measurement
period begins and 114 days
after the IPSD measurement
period ends (e.g., September
23, 2016 – August 22, 2017)

Continuous Enrollment
Period

Continuation Phase: The
Negative medication history time period between 231
review: The time period
days after the IPSD
between 105 days before the measurement period begins
IPSD measurement period
and 231 days after the IPSD
begins and 105 days before measurement period ends
the IPSD measurement
(e.g., January 18, 2017 –
period ends (e.g., February
December 17, 2017)
17, 2016 – January 15,
2017)
Initiation and Engagement of For the denominator, two
Alcohol and Other Drug
measurement periods are
(AOD) Dependence
used:
Treatment (IET-BH) (cont’d)
The Index Episode Start
Date (IESD) measurement
period is the first 10 months
and 15 days of the
measurement year. (e.g.,
Jan. 1, 2017 – Nov. 15,
2017)

For the numerator, two
measurement periods are
used:
The Initiation of AOD
Treatment measurement
period covers the 13 days
following the IESD. It
begins on the 1st day of the
first month and ends 13
days after the measurement

60 days (2 months) prior to
the IESD through 44 days
after the IESD (105 total
days)
(e.g., Nov. 1, 2016 – Dec. 29,
2017)

14

Appendix A. Measurement Period for Denominators and Numerators for the BHC Metrics and Quality Measures

Measure

Denominator

Alcohol and Other Drug
The Negative Diagnosis
(AOD) Dependence
History Review
Treatment (IET-BH) (cont’d) measurement period looks
back 60 days prior to the
IESD. It begins 60 days
prior to the measurement
year and ends 60 days prior
to the last possible date of
the IESD during the
measurement year. (e.g.,
Nov. 2, 2016 – Sept. 16,
2017)

Numerator

Continuous Enrollment
Period

period for the IESD ends.
(e.g., Jan. 1, 2017 – Nov.
28, 2017)
The Engagement of AOD
Treatment measurement
period covers the 29 days
following Initiation of AOD
Treatment. It begins on the
2nd day of the first month
and ends 29 days after the
measurement period for
Initiation. (e.g., Jan. 2,
2017 – Dec. 27, 2017)

15

Appendix B. BHC Value Set Directory User Manual

Appendix B. BHC Value Set Directory User Manual

A.

What Is the Value Set Directory?

Many measure specifications, including those for HEDIS® measures, reference value sets. A “value
set” is the complete set of codes used to identify a service or condition included in a measure. The
BHC Value Set Directory (VSD) includes all value sets and codes needed to report many of the
BHC measures. This appendix is based upon one written for the HEDIS measures that are part of the
CMS Child or Adult Core Sets for Medicaid/CHIP and describes how to use value sets in calculating
measures in the BHC set, including for non-HEDIS measures.
B.

Structure of the Value Set Directory

The VSD (Excel workbook) contains the following spreadsheets:
BHC Measures to Value Sets
BHC Value Sets to Codes
The columns in the value sets are based on those included in the National Library of Medicine Value
Set Authority Center (VSAC) standardized value set file. Not all columns will be needed for
reporting BHC HEDIS measures, depending on how the state’s information systems are organized.
All columns have been included in the value set to preserve consistency with the national standard.
Note: Due to licensing restrictions NCQA is prohibited from providing an unlocked, editable
version of the BHC Value Sets to Codes spreadsheet.
C.

Measures to Value Sets

The BHC Measures to Value Sets spreadsheet lists value sets by measure and includes the elements
in Table B.1.
Table B.1. Measures to Value Sets
Element Name

Element Description

Measure ID

The abbreviation for the measure

Measure Name

The measure name

Value Set Name

The value set name

Value Set OID

Unique identifier for the value set

Use the BHC Measures to Value Sets spreadsheet to identify all value sets used for a particular
measure or to identify all measures that use a specific value set. For example, setting the Measure ID
filter to “WCC” demonstrates that the Weight Assessment and Counseling: Body Mass Index
Assessment for Children/Adolescents measure uses the following value sets:

16

Appendix B. BHC Value Set Directory User Manual

Measure
ID

Measure Name

Value Set Name

Value Set OID

WCC-BH

Weight Assessment and BMI Percentile
Counseling: Body Mass
Index (BMI)
Assessment for
Children/Adolescents

2.16.840.1.113883.3.464.1004.1038

WCC-BH

Weight Assessment and Pregnancy
Counseling: Body Mass
Index (BMI)
Assessment for
Children/Adolescents

2.16.840.1.113883.3.464.1004.1219

Setting the Value Set Name filter to “Pregnancy” identifies the three measures that use the value set.
Measure
ID

Measure Name

CBP-BH

Controlling High Blood
Pressure

Pregnancy

2.16.840.1.113883.3.464.1004.1219

PCR-BH

Plan All-Cause
Readmissions

Pregnancy

2.16.840.1.113883.3.464.1004.1219

WCC-BH

Weight Assessment and
Counseling: Body Mass
Index Assessment for
Children/Adolescents

Pregnancy

2.16.840.1.113883.3.464.1004.1219

D.

Value Set Name

Value Set OID

Value Sets to Codes

The BHC Value Sets to Codes spreadsheet lists the codes included in each value set and includes the
elements in Table B.2.
Table B.2. Value Sets to Codes
Element Name

Element Description

Value Set Name

The value set name

Value Set OID

Unique identifier for the value set

Value Set Version

The version date for the value set directory (2015-12-21 for federal
fiscal year 2016 reporting)

Code

The code

Definition

The code definition
Note: The definition is not included for Uniform Bill, 2 CPT3 or the
American Dental Association’s Code on Dental Procedures and
Nomenclature (CDT) codes due to licensing restrictions.
17

Appendix B. BHC Value Set Directory User Manual

Element Name

Element Description

Code System

The code system for the code. Code systems are labeled as:
CPT: Current Procedural Terminology
HCPCS: Healthcare Common Procedure Coding System Level II
ICD-10-CM: International Classification of Diseases, 10th
Revision, Clinical Modification (Diagnosis codes)
ICD-10-PCS: International Classification of Diseases, 10th Revision,
Procedure Coding System (Procedure codes)
ICD-9-CM: International Classification of Diseases, 9th Revision,
Clinical Modification (Diagnosis codes)
ICD-9-PCS: International Classification of Diseases, 9th Revision,
Clinical Modification (Procedure codes)
POS: CMS Place of Service
UBREV: Uniform Bill (Revenue codes)
UBTOB: Uniform Bill (Type of Bill codes)

Code System OID

Unique identifier for the code system.

Code System Version Code system version tracking number.
1
Uniform Bill Codes (“UB Codes”) are protected under federal copyright laws and are owned by the
American Hospital Association (AHA). The UB Codes in the HEDIS specifications are included
with the permission of the AHA. The UB Codes contained in the HEDIS specifications may be
used by health plans and other health care delivery organizations for the purpose of calculating and
reporting HEDIS results or using HEDIS measure results for their internal quality improvement
purposes. All other uses of the UB Codes require a license from the AHA. Software vendors and all
others desiring to use the UB Codes in a commercial product to generate HEDIS results, or for any
other use, must obtain a commercial use license directly from the AHA. To inquire about licensing,
contact [email protected].
2

CPT codes copyright 2015 American Medical Association. All rights reserved. CPT is a trademark
of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT.
The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions
apply to government use.

18

Appendix B. BHC Value Set Directory User Manual

Use the Value Sets to Codes spreadsheet to identify all codes in a value set or to identify all value sets that use a particular code. For
example, setting the Value Set Name filter to “Narcolepsy” demonstrates that the following codes are included in the value set.
Value Set
Name

Value Set OID

Value Set
Version

Code

Definition

Code
System

Code System OID

Code
System
Version

Narcolepsy

2.16.840.1.113883.3.4 2015-12-21
64.1004.1182

347.01

Narcolepsy, with ICD-9-CM 2.16.840.1.113883.6.10 2014.1.13A
cataplexy
3
A

Narcolepsy

2.16.840.1.113883.3.4 2015-12-21
64.1004.1182

347.11

Narcolepsy in
conditions
classified
elsewhere, with
cataplexy

ICD-9-CM 2.16.840.1.113883.6.10 2014.1.13A
3
A

Narcolepsy

2.16.840.1.113883.3.4 2015-12-21
64.1004.1182

347.00

Narcolepsy,
without
cataplexy

ICD-9-CM 2.16.840.1.113883.6.10 2014.1.13A
3
A

Narcolepsy

2.16.840.1.113883.3.4 2015-12-21
64.1004.1182

347.10

Narcolepsy in
conditions
classified
elsewhere,
without
cataplexy

ICD-9-CM 2.16.840.1.113883.6.10 2014.1.13A
3
A

Narcolepsy

2.16.840.1.113883.3.4 2015-12-21
64.1004.1182

G47.411

Narcolepsy with ICD-10cataplexy
CM

2.16.840.1.113883.6.90 2014.0.0.13
AA

Narcolepsy

2.16.840.1.113883.3.4 2015-12-21
64.1004.1182

G47.419

Narcolepsy
without
cataplexy

2.16.840.1.113883.6.90 2014.0.0.13
AA

ICD-10CM

Appendix A: CCBHC Core set Value Set Directory User Manual

Value Set
Name

Value Set OID

Value Set
Version

Code

Definition

Code
System

Code System OID

Code
System
Version

Narcolepsy

2.16.840.1.113883.3.4 2015-12-21
64.1004.1182

G47.421

Narcolepsy in
conditions
classified
elsewhere with
cataplexy

ICD-10CM

2.16.840.1.113883.6.90 2014.0.0.13
AA

Narcolepsy

2.16.840.1.113883.3.4 2015-12-21
64.1004.1182

G47.429

Narcolepsy in
conditions
classified
elsewhere
without
cataplexy

ICD-10CM

2.16.840.1.113883.6.90 2014.0.0.13
AA

Setting the Code filter to “002.3” demonstrates that the code is included in the following value set.
Value Set
Name

Value Set OID

Value Set
Version

Acute
Condition

2.16.840.1.113883.3.464. 2015-12-21 002.3
1004.1324

Code

Definition

Code
System

Paratyphoid
fever C

ICD-9CM

Code System OID

Code System
Version

2.16.840.1.113883.6.103 2014.1.13AA

20

Appendix C. Guidance for Selecting Sample Sizes for HEDIS® Hybrid Measures
Appendix C. Guidance for Selecting Sample Sizes for HEDIS® Hybrid Measures

This appendix provides additional information on when it may be feasible to use a sample size of
less than 411 when the hybrid method is used. The sample size is based on the current year’s
administrative rate8 or the prior years reported rate. The guidance in the table below is designed
to minimize the burden of medical record review, while providing an adequate sample size for
calculating the measure.
Table C.1. Determining Sample Sizes for Hybrid Measures when Data Are Available
from the Current Year’s Administrative Rate or the Prior Year’s Reported Rate
Current Year’s Administrative Rate or the Prior
Year’s Reported Rate

Minimum Sample Size

Less than or equal to 50%

411

51%

411

52%

410

53%

410

54%

409

55%

407

56%

405

57%

403

58%

401

59%

398

60%

395

61%

392

62%

388

63%

384

64%

380

65%

376

66%

371

67%

366

8

The administrative rate refers to the performance rate that is calculated using administrative data only, rather than
from any medical record reviews.

21

Appendix C. Guidance for Selecting Sample Sizes for HEDIS® Hybrid Measures
Current Year’s Administrative Rate or the Prior
Year’s Reported Rate

Minimum Sample Size

68%

360

69%

354

70%

348

71%

342

72%

335

73%

328

74%

321

75%

313

76%

305

77%

296

78%

288

79%

279

80%

270

81%

260

82%

250

83%

240

84%

229

85%

219

86%

207

87%

196

88%

184

89%

172

90%

159

91%

147

92%

134

93%

120

94%

106

Greater than or equal to 95%

100

Note:

Truncate the decimal portion of the rate to obtain a whole number.

22

Appendix D. Definitions of Practitioner Types
Appendix D. Definitions of Practitioner Types

PRACTITIONER TYPE DEFINITION
Mental Health Practitioner

A practitioner who provides mental health services and meets any of
the following criteria:
An MD or doctor of osteopathy (DO) who is certified as a
psychiatrist or child psychiatrist by the American Medical Specialties
Board of Psychiatry and Neurology or by the American Osteopathic
Board of Neurology and Psychiatry; or, if not certified, who
successfully completed an accredited program of graduate medical or
osteopathic education in psychiatry or child psychiatry and is
licensed to practice patient care psychiatry or child psychiatry, if
required by the state of practice
An individual who is licensed as a psychologist in his/her state of
practice, if required by the state of practice
An individual who is certified in clinical social work by the
American Board of Examiners; who is listed on the National
Association of Social Worker’s Clinical Register; or who has a
master’s degree in social work and is licensed or certified to practice
as a social worker, if required by the state of practice
A registered nurse (RN) who is certified by the American Nurses
Credentialing Center (a subsidiary of the American Nurses
Association) as a psychiatric nurse or mental health clinical nurse
specialist, or who has a master’s degree in nursing with a
specialization in psychiatric/mental health and two years of
supervised clinical experience and is licensed to practice as a
psychiatric or mental health nurse, if required by the state of practice
An individual (normally with a master’s or a doctoral degree in
marital and family therapy and at least two years of supervised
clinical experience) who is practicing as a marital and family
therapist and is licensed or a certified counselor by the state of
practice, or if licensure or certification is not required by the state of
practice, who is eligible for clinical membership in the American
Association for Marriage and Family Therapy
An individual (normally with a master’s or doctoral degree in
counseling and at least two years of supervised clinical experience)
who is practicing as a professional counselor and who is licensed or
certified to do so by the state of practice, or if licensure or
certification is not required by the state of practice, is a National
Certified Counselor with Specialty Certification in Clinical Mental
Health Counseling from the National Board for Certified Counselors
(NBCC)

23

Appendix D. Definitions of Practitioner Types
PRACTITIONER TYPE DEFINITION
Obstetrical/Gynecological
(OB/GYN) and Other
Prenatal Care Practitioner

Includes:
Physicians certified as obstetricians or gynecologists by the
American Medical Specialties Board of Obstetrics or Gynecology or
the American Osteopathic Association; or, if not certified, who
successfully completed an accredited program of graduate medical or
osteopathic education in obstetrics and gynecology
Certified nurse midwives and nurse practitioners who deliver
prenatal care services in a specialty setting (under the direction of an
OB/GYN certified or accredited provider)

Primary Care Practitioner
(PCP)

A physician or nonphysician (e.g., nurse practitioner, physician
assistant) who offers primary care medical services
Licensed practical nurses and registered nurses are not considered
PCPs

Prescribing Practitioner

A practitioner with prescribing privileges, including nurse practitioners,
physician assistants, and other non-MDs who have the authority to
prescribe medications

24

APPENDICES FOR SPECIFIC MEASURES

25

Appendix ROUT: Routine Care Needs

Appendix ROUT: Routine Care Needs
Percentage of new consumers requesting services who were determined to need
routine care
EXAMPLE
Assuming 10 new consumers during the measurement year (Consumers A through J) with the
data shown in the table below, the percentage of new consumers, stratified by payer status,
presenting with routine (R) vs non-routine (N) needs is shown on the last line of the table below.
Consumer
A

Medicaid

Medicare &
Medicaid

Neither

R

B

Total
R

R

R

C

N

N

D

N

N

E

N

F

N
N

N

G

R

R

H

R

R

I

N

J

N
R

R

Total

5

3

2

10

Routine needs

3

1

1

5

Non-routine
needs

2

2

1

5

3/5=60%

1/3=33%

1/2=50%

5/10=50%

Percent with
routine needs

Metrics interpretation: For the Medicaid eligible population, 60% were identified as
having routine needs; 33% of those with both Medicaid and Medicare had routine needs;
26

Appendix ROUT: Routine Care Needs

and 50% of those with neither had routine needs. Overall across the eligible population,
50% were identified as having routine needs.

27

Appendix I-EVAL: Time to Initial Evaluation

Appendix I-EVAL: Time to Initial Evaluation
Metric #1: The percentage of new consumers with initial evaluation provided
within 10 business days of first contact
Metric #2: The mean number of days until initial evaluation for new consumers
EXAMPLES
METRIC #1
The percentage of new consumers with initial evaluation provided within 10 business
days of first contact:
Denominator: Calculate the denominator as follows, with the measurement period being the
first 11 months of the measurement year (MY) and the 6 months preceding the MY contact:
1. 100 consumers contact clinic in first 11 months of the MY
2. 50 of those were not seen at the clinic in the 6 months preceding the MY contact
3. Of those 50, 20 were Medicaid eligible, 15 were both Medicare and Medicaid
eligible, and 15 were neither.
4. Calculate as follows for stratification by payer:
Steps in calculation

Medicaid

Medicare &
Medicaid

Neither

Total

Number of consumers
who contact clinic in first
11 months of the MY

50

25

25

100

Number of those not seen
at the clinic in the 6
months preceding the MY
contact

20

15

15

50

Denominator stratified by
payer status

20

15

15

50

28

Appendix I-EVAL: Time to Initial Evaluation

Numerator: Calculate the numerator for stratification by payer as follows, with the
measurement period being the measurement year (MY):
Steps in calculation

Medicaid

Medicare &
Medicaid

Neither

Total

Denominator stratified by
payer status

20

15

15

50

Seen within 10 business
days of first contact

19

10

7

36

Numerator stratified by
payer status

19

10

7

36

Quality Metric, the percentage of new consumers with initial evaluation provided
within 10 business days of first contact, by payer status:
Medicaid: 19/20 = .950 = .95 or 95%
Medicare & Medicaid: 10/15 = .667 = .67 or 67%
Neither: 7/15 = .467 = .47 or 47%
Total: 36/50 = .720 = .72 or 72%
Metrics interpretation: For the Medicaid eligible population, 95% received an initial
evaluation within 10 days of their initial contact with the BHC; whereas, only 67% of
those dually eligible for Medicare and Medicaid and only 47% of consumers without
Medicare or Medicaid (referred to as “Neither”) received a similar initial evaluation.
Overall, across the eligible population, 72% received an initial evaluation within 10 days
of their initial contact with the BHC.
See below for similar calculation stratified by age:
Denominator:
Steps in calculation

Aged 12-17

Aged 18 and older

Total

Number of consumers
who contact clinic in first
11 months of the MY

25

75

100

Number of those not seen
at the clinic in the 6
months preceding the MY
contact

10

40

50

29

Appendix I-EVAL: Time to Initial Evaluation

Steps in calculation

Aged 12-17

Aged 18 and older

Total

10

40

50

Aged 12-17

Aged 18 and older

Total

10

40

50

Seen within 10 business
days of first contact

3

33

36

Numerator stratified by
age

3

33

36

Denominator stratified by
age
Numerator:
Steps in calculation
Denominator stratified by
age

Quality Metric, the percentage of new consumers with initial evaluation provided
within 10 business days of first contact, by age category:
Aged 12-17 years: 3/10 = .300 = .30 or 30%
Aged 18 years and older: 33/40 = .825 = .83 or 83%
Total: 36/50 = .720 = .72 or 72%
Metrics interpretation: For those consumers in the eligible population aged 18 years and
older, 83% received an initial evaluation within 10 days of their initial contact with the
BHC, compared to 30% of consumers aged 12-17 years of age who received an initial
evaluation.
METRIC #2
The mean number of days until initial evaluation for new consumers:
Assuming 10 consumers (Consumers A through J) seen during the first 11 months of the
measurement year and not seen at the clinic in the prior 6 months with counts by payer status as
shown below:
Denominator: The number of eligible consumers:
Number of
consumers

Medicaid

Medicare &
Medicaid

Neither

Total

4

3

3

10

30

Appendix I-EVAL: Time to Initial Evaluation

Numerator: The total number of business days between first contact and initial evaluation
(stratified by payer status):
Consumer

Medicare &
Medicaid

Neither

Total

A

10

10

B

15

15

C

8

8

D

31*

31*

E

20

20

F

13

13

G

3

3

H

4

4

I

3

3

J

31*

31*

38

138

Total
Numerator
*

Medicaid

64

36

First contact at the end of the 11th month of the MY and not seen again for initial evaluation.
Quality Metric, the mean number of days until initial evaluation for new consumers, by
payer status:
Medicaid: 64/ 4 = 16 days
Medicare & Medicaid: 36/3 = 12 days
Neither: 38/3 = 12.7 days
Total: 138/10 = 13.8 days
Metrics interpretation: For the Medicaid new consumers in the eligible population,
an average of 16 days elapsed until initial evaluation; whereas, those consumers
who had neither Medicaid or Medicare (referred to as “Neither”) had 12.7 days on
average before an initial evaluation.

See below for similar calculation stratified by age:
Denominator:
31

Appendix I-EVAL: Time to Initial Evaluation

Number of
consumers

Aged 12-17 years

Aged 18 years and older

Total

3

7

10

Aged 12-17 years

Aged 18 years and older

Total

A

10

10

B

15

15

C

8

8

Numerator:
Consumer

31*

D
E

20

20

F

13

13

G

3

3

H

4

I

4
3

31*

J
Total Numerator
*

31*

66

3
31*

72

138

First contact at the end of the 11th month of the MY and not seen again for initial evaluation.
Quality Metric, the mean number of days until initial evaluation for new consumers, by
age category:
Aged 12-17 years: 66/3 = 33 days
Aged 18 years and older: 72/7 = 10.29 or 10.3 days
Total: 138/10 = 13.8 days
Metrics interpretation: For the new consumers aged 18 years and older in the
eligible population, an average of 10.3 days elapsed until initial evaluation;
whereas, those consumers aged 12-17 years had 33 days on average before an
initial evaluation.

32

Appendix TX-EVAL: Time to Comprehensive Person and Family-Centered Diagnostic and Treatment
Planning Evaluation

Appendix TX-EVAL: Time to Comprehensive Person and Family-Centered
Diagnostic and Treatment Planning Evaluation
The mean number of days after first contact until comprehensive person-centered and
family centered diagnostic and treatment planning evaluation is performed for new
consumers
EXAMPLE
Assuming 10 consumers (Consumers A through J) seen during the first 9 months of the
measurement year and not seen at the clinic in the prior 6 months with counts by payer status as
shown below:
Denominator: The number of eligible consumers:
Number of
consumers

Medicaid

Medicare &
Medicaid

Neither

Total

4

3

3

10

Numerator:
The total number of days between first contact and comprehensive evaluation (stratified by payer
status):
Consumer

Medicaid

Medicare &
Medicaid

Neither

Total

A

100

100

B

150

150

C

40

40

D

91*

91*

E

30

30

F

45

45

G

55

55

H

34

34

I

45

45
33

Appendix TX-EVAL: Time to Comprehensive Person and Family-Centered Diagnostic and Treatment
Planning Evaluation

Consumer

Medicaid

Medicare &
Medicaid

J
Total Numerator

381

130

Neither

Total

91*

91*

170

681

*

First contact at the end of the 9th month of the MY and not seen again for comprehensive
evaluation.
Quality Metric, the mean number of days after first contact until comprehensive
person-centered and family centered diagnostic and treatment planning evaluation
is performed for new consumers, by payer status:
Medicaid: 381/4 = 95.3 days
Medicare & Medicaid: 130/3 = 43.3 days
Neither: 170/3 = 56.7 days
Total: 681/10 = 68.1 days
Metrics interpretation: For the Medicaid consumers in the eligible population, on
average, 95.3 days elapsed between first contact until comprehensive person centered and family centered diagnostic and treatment planning evaluation is
performed for these new consumers, in contrast to 68.1 days for the total population.
See below for similar calculation stratified by age:
Denominator:
Number of
consumers

Aged 12-17 years

Aged 18 years and older

Total

3

7

10

Aged 12-17 years

Aged 18 years and older

Total

100

100

Numerator:
Consumer
A
B
C

150

150
40

40

34

Appendix TX-EVAL: Time to Comprehensive Person and Family-Centered Diagnostic and Treatment
Planning Evaluation

Consumer

Aged 12-17 years

Aged 18 years and older

Total

D

91*

91*

E

30

30

F

45

45

G

55

55

H

34

34

I

45

45

J

91*

Total Numerator

286

91*
395

681

*

First contact at the end of the 11th month of the MY and not seen again for comprehensive
evaluation.
Quality Metric, the mean number of days after first contact until comprehensive
person-centered and family centered diagnostic and treatment planning
evaluation is performed for new consumers, by age category:
Aged 12-17 years: 286/3 = 95.3 days
Aged 18 years and older: 395/7 = 56.4 days
Total: 681/10 = 68.1 days
Metrics interpretation: For the consumers in the eligible population aged 18 years
and older, on average, 56.4 days elapsed between first contact until comprehensive
person-centered and family centered diagnostic and treatment planning evaluation
is performed for these new consumers; whereas, for those consumers aged 12 -17
years, over 95 days elapsed between the 2 events.

35

Appendix SUIC: Deaths by Suicide

Appendix SUIC: Deaths by Suicide
Percentage of consumers aged 12 years and older who died by suicide during the
measurement year
EXAMPLE
Calculate the metric stratified by age as follows:
Age

Number of consumers

Number of suicides

Percentage

12–17 years

60

2

2/60 = .03 or 3%

18–64 years

100

4

4/100 = .04 or 4%

65 years and
older

50

2

2/50 = .04 or 4%

210

8

8/210 = .04 or 4%

Total

Metrics interpretation: Consumers ages 12-17 had the lowest rate of deaths by
suicide (3% in contrast to 4% for the rest of the population.
Calculate the metric stratified by payer status as follows:
Payer status

Number of consumers

Number of suicides

Percentage

100

4

4/100 = .04 or 4%

Medicare and
Medicaid

70

3

3/70 = .04 or 4%

Neither

40

1

1/40 = .03 or 3%

210

8

8/210 = .04 or 4%

Medicaid
only

Total

Metrics interpretation: Consumers who had neither Medicaid nor dual eligibility for
Medicare and Medicaid had the lowest rate of deaths by suicide (3% in contrast to 4% for
all other payer groups).

36

Appendix DOC.A: Documentation of Current Medications in the Medical Record

Appendix DOC.A: Documentation of Current Medications in the Medical
Record
Percentage of visits for consumers aged 18 years and older for which the eligible
professional attests to documenting a list of current medications using all immediate
resources available on the date of the encounter. This list must include ALL known
prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional)
supplements AND must contain the medications’ name, dosage, frequency and route of
administration.
EXAMPLE
Eligible Population or Denominator: Calculate the denominator as follows, with the
measurement period being the measurement year (MY):
1. Number of consumers aged 18 or older who were seen at the clinic during the MY: 1,000
2. Number of visits during the MY by those 1,000 consumers: 6,000
3. Number of visits where the consumer was in an urgent or emergent medical situation
where time was of the essence and to delay treatment would jeopardize the consumer’s
health status: 500
4. Of the 5,500 nonexcluded visits, 3,000 are by Medicaid beneficiaries, 1,000 are by
consumers who are beneficiaries of both Medicare and Medicaid, and 1,500 are by
consumers who are neither.

37

Appendix DOC.A: Documentation of Current Medications in the Medical Record

Calculate as follows:
Steps in calculation

Medicaid

Medicare &
Medicaid

Neither

Total

Number of visits by age
and encounter-eligible
consumers during the
MY

3,200

1,200

1,600

6,000

From those, exclude
visits where there were
medical reasons for not
screening (G8430)

200

200

100

500

3,200-200 =
3,000

1,200-200 =
1,000

1,600-100 =
1,500

6,000-500 =
5,500

Denominator

Numerator: Calculate the numerator as follows, with the measurement period being the
MY:
Steps in calculation

Medicaid

Medicare &
Medicaid

Neither

Total

Denominator

3,000

1,000

1,500

5,500

Documentation of
current medications in
medical record (G8427)

2,500

800

1,000

4,300

No documentation of
current medications in
medical record (G8428)

500

200

500

1,200

2,500

800

1,000

4,300

Numerator

Quality Measure, percentage of visits for consumers aged 18 years and older for which
the eligible professional attests to documenting a list of current medications on the date
of the encounter:
Medicaid: 2,500/3,000 = .833 = .83 or 83%
Medicare & Medicaid: 800/1,000 = .800 = .80 or 80%
Neither: 1,000/1,500 = .666 = .67 or 67%

38

Appendix DOC.A: Documentation of Current Medications in the Medical Record

Total: 4,300/5,500 = .782 = .78 or 78%
Measure interpretation: For the Medicaid consumers aged 18 years and older in the
eligible population, 83% of their visits had documentation that a list of current
medications was available on the date of the encounter.

39

Appendix DOC.B: Documentation of Current Medications in the Medical Record

Appendix DOC.B: Documentation of Current Medications in the Medical
Record
Codes that may apply to this measure are provided below.
Category

Codes

Eligible population step 1,
encounter codes

90791, 90792, 90832, 90834, 90837, 90839, 90957, 90958,
90959, 90960, 90962, 90965, 90966, 92002, 92004, 92012,
92014, 92507, 92508, 92526, 92541, 92542, 92543, 92544,
92545, 92547, 92548, 92557, 92567, 92568, 92570, 92585,
92588, 92626, 96116, 96150, 96151, 96152, 97001, 97002,
97003, 97004, 97532, 97802, 97803, 97804, 98960, 98961,
98962, 99201, 99202, 99203, 99204, 99205, 99212, 99213,
99214, 99215, 99221, 99222, 99223, 99324, 99325, 99326,
99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342,
99343, 99344, 99345, 99347, 99348, 99349, 99350, 99495,
99496, G0101, G0108, G0270, G0402, G0438, G0439
G8430

Current Medications not
Documented, Patient not
Eligible
Eligible professional attests to
documenting in the medical
record they obtained, updated,
or reviewed the consumer’s
current medications

G8427

Current list of medications not
documented as obtained,
updated, or reviewed by the
eligible professional, reason not
given

G8428

40

Appendix BMI-SF.A: Preventive Care & Screening: Adult Body Mass Index (BMI) Screening & Follow-Up

Appendix BMI-SF.A: Preventive Care & Screening: Body Mass Index (BMI)
Screening & Follow-Up
Percentage of consumers aged 18 years and older with a BMI documented during the
current encounter or during the previous six months AND with a BMI of normal
parameters, a follow-up plan is documented during the encounter or during the previous
six months of the current encounter.
Normal Parameters: Age 65 years and older BMI > 23 and < 30 kg/m2
Age 18 - 64 years BMI > 18.5 and < 25 kg/m2
EXAMPLE
Eligible Population or Denominator: Calculate the denominator as follows, with the
measurement period being the measurement year (MY):
1. Consumers aged 18 years or older who were seen at the clinic with one of the
denominator-eligible encounter codes during the MY: 200
2. Exclusions:
a. BMI Not Documented, Consumer Not Eligible: 15
b. BMI Documented Outside of Normal Limits and Follow-Up Plan Not
Documented in MY, Consumer Not Eligible: 4
c. No quality-data codes reported: 1
200-20=180
3. Of the 180 non-excluded consumers, 100 are Medicaid beneficiaries, 20 are Medicaid &
Medicare eligible, and 60 are neither.
Calculate as follows:
Steps in calculation
Consumers aged 18
years or older seen
during MY with
denominator-eligible
encounter codes

Medicaid
109

Medicaid &
Medicare
28

Neither

Total
63

200

41

Appendix BMI-SF.A: Preventive Care & Screening: Adult Body Mass Index (BMI) Screening & Follow-Up

Steps in calculation

Medicaid &
Medicare

Medicaid

Neither

Total

BMI Not Documented,
Consumer Not Eligible
(G8422)

6

7

2

15

BMI Documented Out
of Normal Limits,
Follow-Up Plan Not
Documented in MY,
Consumer Not Eligible
(G8938)

2

1

1

4

No quality-data
numerator codes
reported

1

0

0

1

100

20

60

180

Denominator

Numerator: Calculate as follows, with the measurement period for the numerator being
the measurement year and six months prior:

Steps in calculation
Denominator

Medicaid &
Medicare

Medicaid

Neither

Total

100

20

60

180

BMI Not Documented,
Reason not Given
(G8421)

4

1

8

13

BMI Documented
Outside of Normal
Parameters, Follow-Up
Plan not Documented,
Reason not Given
(G8419)

7

1

10

18

89

18

42

149

Numerator

Quality Measure, Percentage of consumers aged 18 years and older with a BMI
documented during the current encounter or during the previous six months AND with

42

Appendix BMI-SF.A: Preventive Care & Screening: Adult Body Mass Index (BMI) Screening & Follow-Up

a BMI of normal parameters, and with a follow-up plan documented during the
encounter or during the previous six months of the current encounter:
Medicaid: 89/100 = .890 = .89 or 89%
Medicaid & Medicare: 18/20 = .900 = .90 or 90%
Neither: 42/60 = .700 = .70 or 70%
Total: 149/180 = .827 = .83 or 83%
Metric interpretation: 89% of the Medicaid consumers in the eligible population who
were 18 years and older with a BMI documented during the current encounter or during
the previous six months AND with a BMI of normal parameters, had a follow -up plan
that was documented during the encounter or during the previous six months of the
current encounter; whereas, only 70% of consumers without Medicaid or Medicare
(referred to as “Neither”) had a follow-up plan documented under the same criteria.

43

Appendix BMI-SF.B. Codes Relevant to Preventive Care & Screening: Adult Body Mass Index (BMI)
Screening and Follow-Up

Appendix BMI-SF.B. Codes Relevant to Preventive Care & Screening: Adult
Body Mass Index (BMI) Screening and Follow-Up
Codes that may apply to this measure are provided below.
Category

Codes

Eligible population step 2, encounter codes

90791, 90792, 90832, 90834, 90837, 90839,
96150, 96151, 96152, 97001, 97003, 97802,
97803, 98960, 99201, 99202, 99203, 99204,
99205, 99212, 99213, 99214, 99215, D7140,
D7210, G0101, G0108, G0270, G0271,
G0402, G0438, G0439, G0447
G8422

BMI not documented with documentation the
consumer is not eligible for BMI calculation
BMI is documented as being outside of
normal limits, follow-up plan is not
documented, documentation shows the
consumer is not eligible

G8938

BMI is documented within normal parameters
and no follow up plan is required

G8420

BMI is documented above normal parameters
and a follow-up plan is documented

G8417

BMI is documented below normal parameters
and a follow-up plan is documented

G8418

BMI not documented and no reason is given

G8421

BMI documented outside normal parameters,
no follow-up plan documented, no reason
given

G8419

44

Appendix CBP-BH: Controlling High Blood Pressure
Please see NCQA Notice of Copyright and Disclaimers in front matter to Volume 1 of this manual.

Appendix CBP-BH. Controlling High Blood Pressure
Table CBP-A: Prescriptions to Identify Consumers with Diabetes
Description

Prescription

Alpha-glucosidase inhibitors

Acarbose
Miglitol

Amylin analogs

Pramlinitide

Antidiabetic combinations

Alogliptin-metformin
Alogliptin-pioglitazone
Canaglifozin-metformin
Empaglifozin-linagliptin
Empagliflozin/metformin
Glimepiride-pioglitazone
Glimepiride-rosiglitazone
Glipizide-metformin
Glyburide-metformin
Linagliptin-metformin
Metformin-pioglitazone

ROU G H DRAFT

Metformin-repaglinide
Metformin-rosiglitazone
Metformin-saxagliptin
Metformin-sitagliptin
Sitagliptin-simvastatin
Insulin

Insulin aspart
Insulin aspart-insulin aspart protamine
Insulin detemir
Insulin glargine
Insulin glulisine
Insulin human inhaled
Insulin isophane human
Insulin isophane-insulin regular
Insulin lispro
Insulin lispro-insulin lispro protamine
Insulin regular human

45

Appendix CBP-BH: Controlling High Blood Pressure
Please see NCQA Notice of Copyright and Disclaimers in front matter to Volume 1 of this manual.

Description

Prescription

Meglitinides

Nateglinide
Repaglinide

Glucagon-like peptide-1 (GLP1) agonists

Dulaglutide
Exenatide
Liraglutide
Albiglutide

Sodium glucose cotransporter 2 (SGLT2)
inhibitor

Canagliflozin
Dapagliflozin
Empagliflozin

Sulfonylureas

Chlorpropamide
Glimepiride
Glipizide
Glyburide
Tolazamide Tolbutamide

Thiazolidinediones

Pioglitazone
Rosiglitazone
ROU G H DRAFT

Dipeptidyl peptidase-4 (DDP-4) inhibitors

Alogliptin
Linagliptin
Saxagliptin
Sitaglipin

Note: Glucophage/metformin as a solo agent is not included because it is used to treat conditions
other than diabetes; consumers with diabetes on these medications are identified through
diagnosis codes only.
Note: Table CBP-A corresponds to NDC Code Table CDC-A posted to HEDIS NDC page

46

Appendix TSC.A: Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention

Appendix TSC.A: Preventive Care & Screening: Tobacco Use: Screening &
Cessation Intervention

Percentage of consumers aged 18 years and older who were screened for tobacco
use one or more times within 24 months AND who received cessation intervention
if identified as a tobacco user
EXAMPLE
Eligible Population or Denominator: Calculate the denominator as follows, with the
measurement period (MP) being the measurement year (MY):
1. Consumers seen at the clinic who were aged 18 years or older on the date of first
denominator eligible visit during the MY: 200
2. Of the 200 consumers, 100 are Medicaid beneficiaries, 50 are beneficiaries of both
Medicare and Medicaid, and 50 are neither.
3. Consumers without quality-data code needed for numerator: 13
Calculate as follows:
Steps in calculation
Age and encountereligible consumers seen
during MY
No quality-data
numerator codes
reported
Denominator

Medicaid

Medicare &
Medicaid

Neither

Total

100

50

50

200

5

5

3

13

95

45

47

187

47

Appendix TSC.A: Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention

Numerator: Calculate the numerator as follows, with the MP being the measurement
year and the year before:
Steps in calculation

Medicaid

Medicare &
Medicaid

Neither

Total

Denominator

95

45

47

187

Remove consumers
with a documented
medical reason for not
screening for tobacco
use during the MY or
the year prior (4004F
with 1P)

15

30

2

47

Exclude consumers not
screened for tobacco
use during the MP,
reason not otherwise
specified (4004F with
8P)

10

7

8

25

Exclude consumers
who were screened for
tobacco use and who
were identified as
tobacco users, but who
did not receive a
tobacco cessation
intervention during the
MP, reason not
otherwise specified
(4004F with 8P)

16

5

10

37

95-41=54

45-42=3

47-20=27

187-109=78

Numerator

Quality Measure, percentage of consumers aged 18 years and older who were screened
for tobacco use one or more times within 24 months AND who received cessation
intervention if identified as a tobacco user :
Medicaid: 54/95 = .57 or 57%

48

Appendix TSC.A: Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention

Medicare & Medicaid: 3/45 = .07 or 7%
Neither: 27/47 = .57 or 57%
Total: 78/187 = .530 = .42 or 42%
Measure interpretation: For the Medicaid consumers in the eligible population,
57% aged 18 years and older were screened for tobacco use one or more times
within 24 months AND received cessation intervention if identified as a tobacco
user.

49

Appendix TSC.B: Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention

Appendix TSC.B: Preventive Care & Screening: Tobacco Use:
Screening & Cessation Intervention
Codes that may apply to this measure are provided below.
Category

Codes

Eligible population step 3,
encounter codes

90791, 90792, 90832, 90834, 90837, 90845, 92002, 92004,
92012, 92014, 92521, 92522, 92523, 92524, 92540, 92557,
92625, 96150, 96151, 96152, 97003, 97004, 99201, 99202,
99203, 99204, 99205, 99212, 99213, 99214, 99215, 99406,
99407, G0438, G0439
CPT II 4004F with 1P

Documentation of medical
reason(s) for not screening for
tobacco use (e.g., limited life
expectancy, other medical
reasons)
Consumer screened for tobacco
use AND received tobacco
cessation intervention
(counseling, pharmacotherapy,
or both), if identified as a
tobacco user

CPT II 4004F

Consumer screened for tobacco
use and identified as a non-user
of tobacco

CPT II 1036F

Tobacco screening OR tobacco CPT II 4004F with 8P
cessation intervention not
performed, reason not otherwise
specified

50

Appendix ASC.A: Preventive Care & Screening: Unhealthy Alcohol Use: Screening & Brief Counseling

Appendix ASC.A: Preventive Care & Screening: Unhealthy Alcohol Use:
Screening & Brief Counseling
Percentage of consumers aged 18 years and older who were screened at least once
within the last 24 months for unhealthy alcohol use using a systematic screening
method AND who received brief counseling if identified as an unhealthy alcohol
user
EXAMPLE
Eligible Population or Denominator: Calculate the denominator as follows, with the
measurement period being the measurement year (MY):
1. Consumers seen at the clinic who were aged 18 or older on the date of first denominatoreligible visit during the MY: 200
2. Of the 200 consumers, 100 are Medicaid beneficiaries, 50 are beneficiaries of both
Medicare and Medicaid, and 50 are neither.
3. Consumers seen at least twice for any denominator-eligible visit or at least once for
preventive care visit during the MY: 140
4. Consumers without quality-data code needed for numerator: 13

51

Appendix ASC.A: Preventive Care & Screening: Unhealthy Alcohol Use: Screening & Brief Counseling

Calculate as follows:
Steps in calculation

Medicaid

Medicare &
Medicaid

Neither

Total

Age-eligible consumers
seen during MY

100

50

50

200

From those, consumers
who were seen at least
twice for any
denominator-eligible
visit or at least once for
preventive care visit
during the MY

70

40

30

140

5

5

3

13

70-5=65

40-5=35

30-3=27

140-13=127

No quality-data
numerator codes
reported
Denominator

Numerator: Calculate the numerator as follows, with the measurement period (MP)
being the measurement year and the year before:
Steps in calculation
Denominator
From those, remove
consumers with a
documented medical
reason(s) for not
screening for unhealthy
alcohol use in the MY
or the year prior
(G9623)

Medicaid

Medicare &
Medicaid

Neither

Total

65

35

27

127

5

5

3

13

52

Appendix ASC.A: Preventive Care & Screening: Unhealthy Alcohol Use: Screening & Brief Counseling

Steps in calculation

Medicaid

Medicare &
Medicaid

Neither

Total

From those, exclude
consumers not
screened during the
MP using a systematic
screening method
(G9624)

10

10

10

30

From those, exclude
consumers identified as
unhealthy alcohol users
when screened for
unhealthy alcohol use
at least once during
MP, who did not
receive brief
counseling during MP
(G9624)

25

10

10

45

65-40=25

35-25=10

Numerator

27-23=4 127-88=39

Quality Measure, percentage of consumers aged 18 years and older who were
screened at least once within the last 24 months for unhealthy alcohol use using
a systematic screening method AND who received brief counseling if identified
as an unhealthy alcohol user:
Medicaid: 25/65 = .38 or 38%
Medicare & Medicaid: 10/35 = .29 or 29%
Neither: 4/27 =.15 or 15%
Total: 39/127 = .31 or 31%
Measure interpretation: Of the Medicaid consumers within the eligible population
aged 18 years and older, 38% were screened at least once within the last 24
months for unhealthy alcohol use using a systematic screening method AND
received brief counseling if identified as an unhealthy alcohol user; whereas, for
those consumers without Medicare or Medicaid coverage, referred to as “Neither ,”
only 15% received such screening and counseling.

53

Appendix ASC.B: Preventive Care & Screening: Unhealthy Alcohol Use: Screening & Brief Counseling

Appendix ASC.B: Preventive Care & Screening: Unhealthy Alcohol Use:
Screening & Brief Counseling
Codes that may apply to this measure are provided below.
Category

Codes

Eligible population step 3, non- 90791, 90792, 90832, 90834, 90837, 90845, 96150, 96151,
preventive care encounter codes 96152, 97003, 97004, 97802, 97803, 97804, 99201, 99202,
99203, 99204, 99205, 99212, 99213, 99214, 99215, G0270,
G0271
Eligible population step 3,
preventive care encounter codes

G0438, G0439

Documentation of medical
reason(s) for not screening for
unhealthy alcohol use (e.g.,
limited life expectancy, other
medical reasons)

G9623

Consumer identified as an
unhealthy alcohol user when
screened for unhealthy alcohol
use using a systematic
screening method and received
brief counseling

G9621

Consumer not identified as an
unhealthy alcohol user when
screened for unhealthy alcohol
use using a systematic
screening method

G9622

Consumer not screened for
unhealthy alcohol screening
using a systematic screening
method OR consumer did not
receive brief counseling, reason
not given

G9624

54

Appendix SRA-BH-C: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-BH-C) Measure

Appendix SRA-BH-C: eCQM Flow for Reporting the Suicide Risk
Assessment (SRA-BH-C) Measure
Refer to the specific section of the SRA-BH-C specifications to identify the Quality Data
Model (QDM) data elements and associated value sets for use in reporting this measure.
1.

Start Initial Consumer Population

2.

Check Consumer Characteristic Birthdate:
a. If QDM data element, BIRTH DATE, is greater than or equal to 6 years of age AND less
than 17 years of age before the start of the measurement period equals No, do not
include in Initial Consumer Population. Stop Processing.
b. If QDM data element, BIRTH DATE, is greater than or equal to 6 years of age AND less
than 17 years of age before the start of the measurement period, equals Yes, continue
processing and proceed to check Encounter Performed.

3.

Check Encounter Performed: Total number of encounters must be greater than or equal to
2:
a. If QDM data element, OFFICE VISIT, during the measurement period equals Yes,
include in the Initial Consumer Population and proceed to check for another Encounter
Performed until total number of encounters are greater than or equal to 2.
ROU G H DRAFT

b. If QDM data element, OFFICE VISIT, during the measurement period equals No,
proceed to check next Encounter Performed.
c. If QDM data element, OUTPATIENT CONSULTATION, during the measurement
period equals Yes, include in the Initial Consumer Population and proceed to check for
another Encounter Performed until total number of encounters are greater than or equal
to 2.
d. If QDM data element, OUTPATIENT CONSULTATION, during the measurement
period equals No, proceed to check next Encounter Performed.
e. If QDM data element, CONSUMER PROVIDER INTERACTION, during the
measurement period equals Yes, include in the Initial Consumer Population and proceed
to check for another Encounter Performed until total number of encounters are greater
than or equal to 2.
f. If QDM data element, CONSUMER PROVIDER INTERACTION, during the
measurement period equals No, proceed to check next Encounter Performed.
g. If QDM data element, PSYCH VISIT – DIAGNOSTIC EVALUATION, during the
measurement period equals Yes, include in the Initial Consumer Population and proceed

55

Appendix SRA-BH-C: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-BH-C) Measure

to check for another Encounter Performed until total number of encounters are greater
than or equal to 2.
h. If QDM data element, PSYCH VISIT – DIAGNOSTIC EVALUATION, during the
measurement period equals No, proceed to check next Encounter Performed.
i. If QDM data element, PSYCH VISIT – FAMILY PSYCHOTHERAPY, during the
measurement period equals Yes, include in the Initial Consumer Population and proceed
to check for another Encounter Performed until total number of encounters are greater
than or equal to 2.
j. If QDM data element, PSYCH VISIT – FAMILY PSYCHOTHERAPY, during the
measurement period equals No, proceed to check next Encounter Performed.
k. If QDM data element, PSYCHOANALYSIS, during the measurement period equals Yes,
include in the Initial Consumer Population and proceed to check for another Encounter
Performed until total number of encounters are greater than or equal to 2.
l. If QDM data element, PSYCHOANALYSIS, during the measurement period equals No,
proceed to check next Encounter Performed.
m. If QDM data element, GROUP PSYCHOTHERAPY, during the measurement period
equals Yes, include in the Initial Consumer Population and proceed to check for another
Encounter Performed until total number of encounters are greater than or equal to 2.
ROU G H DRAFT

n. If QDM data element, GROUP PSYCHOTHERAPY, during the measurement period
equals No, do not include in the Initial Consumer Population and proceed to check next
Encounter Performed.
o. If QDM data element, PSYCH VISIT - PSYCHOTHERAPY, during the measurement
period equals Yes, include in the Initial Consumer Population and proceed to check
Diagnosis Active if total number of encounters are greater than or equal to 2.
p. If QDM data element, PSYCH VISIT - PSYCHOTHERAPY, during the measurement
period equals No, do not include in the Initial Consumer Population. Stop Processing.
4.

Check Diagnosis Active:
a. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, PSYCH VISIT – DIAGNOSTIC EVALUATION,
during measurement period equals Yes include in Initial Consumer Population and
continue on to the Denominator.
b. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, PSYCH VISIT – DIAGNOSTIC EVALUATION,
during measurement period equals No proceed to check next Diagnosis Active.
56

Appendix SRA-BH-C: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-BH-C) Measure

c. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER -ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, PSYCH VISIT – FAMILY PSYCHOTHERAPY,
during measurement period equals Yes include in Initial Consumer Population and
continue on to the Denominator.
d. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, PSYCH VISIT – FAMILY PSYCHOTHERAPY,
during measurement period equals No, proceed to check next Diagnosis Active.
e. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, FACE-TO-FACE INTERACTION, during
measurement period equals Yes, include in Initial Consumer Population and continue
on to the Denominator.
f. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, FACE-TO-FACE INTERACTION, during
measurement period equals No, proceed to check next Diagnosis Active.
g. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, GROUP PSYCHOTHERAPY, during measurement
period equals Yes, include in Initial Consumer Population and continue on to the
Denominator.
ROU G H DRAFT

h. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, GROUP PSYCHOTHERAPY, during measurement
period equals No, proceed to check next Diagnosis Active.
i. If Occurrence A of QDM data element, MAJOR DEPRESSIVE - ACTIVE, starts before
or during but does not end before the start of Occurrence A of Encounter Performed
QDM data element, OUTPATIENT CONSULTATION, during measurement period
equals Yes, include in Initial Consumer Population and continue on to the Denominator.
j. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, OUTPATIENT CONSULTATION, during
measurement period equals No, proceed to check next Diagnosis Active.
k. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
57

Appendix SRA-BH-C: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-BH-C) Measure

Performed QDM data element, OFFICE VISIT, during measurement period equals Yes,
include in Initial Consumer Population and continue on to the Denominator.
l. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, OFFICE VISIT, during measurement period equals No,
proceed to check next Diagnosis Active.
m. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, PSYCHOANALYSIS, during measurement period
equals Yes, include in Initial Consumer Population and continue on to the Denominator.
n. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, PSYCHOANALYSIS, during measurement period
equals No, proceed to check next Diagnosis active.
o. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE,
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, PSYCH VISIT – PSYCHOTHERAPY, during
measurement period equals Yes, include in Initial Consumer Population and continue
on to the Denominator.
ROU G H DRAFT

p. If Occurrence A of QDM data element, MAJOR DEPRESSIVE DISORDER - ACTIVE
starts before or during but does not end before the start of Occurrence A of Encounter
Performed QDM data element, PSYCH VISIT – PSYCHOTHERAPY, during
measurement period equals No, do not include in the Initial Consumer Population. Stop
Processing.
5.

Start Denominator
a. Denominator equals the Initial Consumer Population. Denominator is represented by the
letter B in the sample calculation listed at the end of this document. Letter B equals 10
consumers in the sample calculation.

6.

Start Numerator

7.

Check Intervention Performed:
a. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, PSYCH VISIT –
DIAGNOSTIC EVALUATION equals Yes, include in the Numerator count. The
Numerator is represented by the letter A in the sample calculation listed at the end of
this document. Letter A equals 5 consumers in the sample calculation.
b. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, PSYCH VISIT –
58

Appendix SRA-BH-C: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-BH-C) Measure

DIAGNOSTIC EVALUATION equals No, proceed to check next Intervention
Performed.
c. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, PSYCH VISIT – FAMILY
PSYCHOTHERAPY equals Yes, include in the Numerator count. The Numerator is
represented by the letter A in the sample calculation listed at the end of this document.
Letter A equals 5 consumers in the sample calculation.
d. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, PSYCH VISIT – FAMILY
PSYCHOTHERAPY equals No, proceed to check next Intervention Performed.
e. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, FACE-TO-FACE
INTERACTION equals Yes, include in the Numerator count. The Numerator is
represented by the letter A in the sample calculation listed at the end of this document.
Letter A equals 5 consumers in the sample calculation.
f. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, FACE-TO-FACE
INTERACTION equals No, proceed to check next Intervention Performed.
g. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, GROUP
PSYCHOTHERAPY equals Yes, include in the Numerator count. The Numerator is
represented by the letter A in the sample calculation listed at the end of this document.
Letter A equals 5 consumers in the sample calculation.
ROU G H DRAFT

h. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, GROUP
PSYCHOTHERAPY equals No, proceed to check next Intervention Performed.
i. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, OUTPATIENT
CONSULTATION equals Yes, include in the Numerator count. The Numerator is
represented by the letter A in the sample calculation listed at the end of this document.
Letter A equals 5 consumers in the sample calculation.
j. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, OUTPATIENT
CONSULTATION equals No, proceed to check next Intervention Performed.
k. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, OFFICE VISIT equals Yes,
include in the Numerator count. The Numerator is represented by the letter A in the
sample calculation listed at the end of this document. Letter A equals 5 consumers in
the sample calculation.
59

Appendix SRA-BH-C: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-BH-C) Measure

l. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, OFFICE VISIT equals No,
proceed to check next Intervention Performed.
m. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, PSYCHOANALYSIS
equals Yes, include in the Numerator count. The Numerator is represented by the letter
A in the sample calculation listed at the end of this document. Letter A equals 5
consumers in the sample calculation.
n. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, PSYCHOANALYSIS
equals No, proceed to check next Intervention Performed.
o. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, PSYCH VISIT PSYCHOTHERAPY equals Yes, include in the Numerator count. The Numerator is
represented by the letter A in the sample calculation listed at the end of this document.
Letter A equals 5 consumers in the sample calculation.
p. If Occurrence A of QDM data element SUICIDE RISK ASSESSMENT during
Occurrence A of Encounter Performed QDM data element, PSYCH VISIT PSYCHOTHERAPY equals No, include in the No/Missing Numerator Data Submitted
count and stop processing.
ROU G H DRAFT

Sample Calculation
Performance Rate = Numerator (a=5 consumers) ÷ Denominator (b=10 consumers) –
Denominator Exclusions (N/A) – Denominator Exceptions (N/A) = 50.00%

60

Appendix SRA-BH-C: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-BH-C) Measure

ROU G H DRAFT

61

Appendix SRA-A.A: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-A) Measure

Appendix SRA-A.A: eCQM Flow for Reporting the Suicide Risk Assessment
(SRA-A) Measure

Refer to the specific section of the SRA-A specifications to identify the Quality Data Model
(QDM) data elements and associated value sets for use in reporting this measure.
1.

Start Initial Consumer Population

2.

Check Consumer Characteristic Birthdate:
a. If the QDM data element, BIRTH DATE, is greater than or equal to 17 years of age
starts before the start of the measurement period equals No, do not include in Initial
Consumer Population. Stop Processing.
b. If the QDM data element, BIRTH DATE, is greater than or equal to 17 years of age
starts before the start of the measurement period, equals Yes continue processing and
proceed to check Diagnosis Active.

3.

Check Diagnosis Active:
a. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element PSYCH VISIT –
DIAGNOSTIC EVALUATION, during the measurement period equals Yes, include in
the Initial Consumer Population and proceed to Denominator.
b. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element PSYCH VISIT –
DIAGNOSTIC EVALUATION, during the measurement period equals No, proceed to
check next Diagnosis Active.
c. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element, PSYCH VISIT PSYCHOTHERAPY, during the measurement period equals Yes, include in the Initial
Consumer Population and proceed to Denominator.
d. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element PSYCH VISIT PSYCHOTHERAPY, during the measurement period equals No, proceed to check next
Diagnosis Active.
e. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element, EMERGENCY
DEPARTMENT VISIT, during the measurement period equals Yes, include in the Initial
Consumer Population and proceed to Denominator.

62

Appendix SRA-A.A: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-A) Measure

f. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element EMERGENCY
DEPARTMENT VISIT, during the measurement period equals No, proceed to check
next Diagnosis Active.
g. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element, OFFICE VISIT, during the
measurement period equals Yes, include in the Initial Consumer Population and proceed
to Denominator.
h. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element OFFICE VISIT, during the
measurement period equals No, proceed to check next Diagnosis Active.
i. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element, OUTPATIENT
CONSULTATION, during the measurement period equals Yes, include in the Initial
Consumer Population and proceed to Denominator.
j. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element OUTPATIENT
CONSULTATION, during the measurement period equals No, proceed to check next
Diagnosis Active.
k. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element, PSYCHOANALYSIS, during
the measurement period equals Yes, include in the Initial Consumer Population and
proceed to Denominator.
l. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element PSYCHOANALYSIS, during
the measurement period equals No, proceed to check next Diagnosis Active.
m. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts
during Occurrence A of Encounter Performed QDM data element, FACE-TO-FACE
INTERACTION, during the measurement period equals Yes, include in the Initial
Consumer Population and proceed to Denominator.
n. If the QDM data element, MAJOR DEPRESSIVE DISORDER ACTIVE, starts during
Occurrence A of Encounter Performed QDM data element FACE-TO-FACE
INTERACTION, during the measurement period equals No, do not include in Initial
Consumer Population. Stop Processing.
4.

Start Denominator

63

Appendix SRA-A.A: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-A) Measure

a. Denominator equals the Initial Consumer Population. Denominator is represented by
the letter B in the sample calculation listed at the end of this document. Letter B equals
10 consumers in the sample calculation.
5.

Start Numerator

6.

Check Intervention Performed:
a. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, PSYCH VISIT – DIAGNOSTIC
EVALUATION equals Yes, include in the Numerator count. The Numerator is
represented by the letter A in the sample calculation listed at the end of this document.
Letter A equals 7 consumers in the sample calculation.
b. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, PSYCH VISIT – DIAGNOSTIC
EVALUATION equals No, proceed to check next Intervention Performed.
c. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, PSYCH VISIT – PSYCHOTHERAPY equals
Yes, include in the Numerator count. The Numerator is represented by the letter A in the
sample calculation listed at the end of this document. Letter A equals 7 consumers in the
sample calculation.
d. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, PSYCH VISIT – PSYCHOTHERAPY equals
No, proceed to check next Intervention Performed.
e. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, EMERGENCY DEPARTMENT VISIT equals
Yes, include in the Numerator count. The Numerator is represented by the letter A in the
sample calculation listed at the end of this document. Letter A equals 7 consumers in the
sample calculation.
f. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, EMERGENCY DEPARTMENT VISIT equals
No, proceed to check next Intervention Performed.
g. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, OFFICE VISIT equals Yes, include in the
Numerator count. The Numerator is represented by the letter A in the sample calculation
listed at the end of this document. Letter A equals 7 consumers in the sample calculation.
h. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, OFFICE VISIT equals No, proceed to check
next Intervention Performed.

64

Appendix SRA-A.A: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-A) Measure

i. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, OUTPATIENT CONSULTATION, equals
Yes, include in the Numerator count. The Numerator is represented by the letter A in the
sample calculation listed at the end of this document. Letter A equals 7 consumers in the
sample calculation.
j. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, OUTPATIENT CONSULTATION equals No,
proceed to check next Intervention Performed.
k. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, PSYCHOANALYSIS, equals Yes, include in
the Numerator count. The Numerator is represented by the letter A in the sample
calculation listed at the end of this document. Letter A equals 7 consumers in the sample
calculation.
l. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, PSYCHOANALYSIS equals No, proceed to
check next Intervention Performed.
m. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, FACE-TO-FACE INTERACTION, equals
Yes, include in the Numerator count. The Numerator is represented by the letter A in the
sample calculation listed at the end of this document. Letter A equals 7 consumers in the
sample calculation.
n. If QDM data element SUICIDE RISK ASSESSMENT during Occurrence A of
Encounter Performed QDM data element, FACE-TO-FACE INTERACTION equals No,
include in No/Missing Numerator Data Submitted. Stop Processing.
Sample Calculation
Performance Rate = Numerator (a=7 consumers) ÷ Denominator (b=10 consumers) –
Denominator Exclusions (N/A) – Denominator Exceptions (N/A) = 70.00%

65

Appendix SRA-A.A: eCQM Flow for Reporting the Suicide Risk Assessment (SRA-A) Measure

66

Appendix SRA-A.B: Major Depressive Disorder (MDD): Suicide Risk Assessment

Appendix SRA-A.B: Major Depressive Disorder (MDD): Suicide Risk
Assessment

Codes that may apply to this measure are provided below.
Category

Codes

Eligible population step 2,
diagnosis and encounter codes

International Classification of Diseases, Tenth Revision,
Clinical Modification (ICD-10-CM) codes for MDD:
F32.0, F32.1, F32.2, F32.3, F32.9, F33.0, F33.1, F33.2,
F33.3, and F33.9
Current Procedural Terminology [CPT ®] codes for the
encounter: 90791, 90792, 90832, 90834, 90837, 90845,
99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214,
99215, 99241, 99242, 99243, 99244, and 99245

67

Appendix SRA-A.C: Major Depressive Disorder (MDD): Suicide Risk Assessment

Appendix SRA-A.C: Major Depressive Disorder (MDD): Suicide Risk
Assessment
Percentage of consumers aged 18 years and older with a diagnosis of Major Depressive
Disorder (MDD) with a suicide risk assessment completed during the visit in which a
new diagnosis or recurrent episode was identified
EXAMPLE
Eligible Population or Denominator: Calculate the denominator as follows, with the
measurement period (MP) being the measurement year (MY):
1. Consumers seen at the clinic during the MY with a denominator-eligible encounter
and new diagnosis or recurrent episode of MDD: 200
2. Of the 200 consumers, 100 are Medicaid beneficiaries, 50 are beneficiaries of both
Medicare and Medicaid, and 50 are neither.
3. Of the 200 consumers, the number that were 18 or older at the time of the diagnosis
or episode: 160
4. Among those 18 or older, the total number of such new diagnoses or recurrent
episodes identified during the MY: 150
Calculate as follows:
Steps in calculation

Medicaid

Medicaid &
Medicare

Neither

Total

The number of
consumers with a new
diagnosis or recurrent
episode of MDD during
the MY

100

50

50

200

Out of those, the number
aged 18 and older at the
time of the new
diagnosis or recurrent
episode

80

35

45

160

68

Appendix SRA-A.C: Major Depressive Disorder (MDD): Suicide Risk Assessment

Steps in calculation

Medicaid

Medicaid &
Medicare

Neither

Total

Among those, the
number of new
diagnoses or recurrent
episodes identified
during the MY

85

30

35

150

Denominator

85

30

35

150

Numerator: Calculate the numerator as follows, with the MP being the MY:
Steps in calculation

Medicaid

Medicare &
Medicaid

Neither

Total

Denominator

85

30

35

150

From the denominator,
the number of visits in
which the diagnosis or
recurrence was
identified, where a
suicide risk assessment
was conducted during
the visit

80

25

20

125

Numerator

80

25

20

125

Quality Measure, percentage of consumers aged 18 years and older with a diagnosis of
Major Depressive Disorder (MDD) and with a suicide risk assessment completed
during the visit in which a new diagnosis or recurrent episode was identified:
Medicaid: 80/85= .941 = .94 or 94%
Medicare & Medicaid: 25/30 = .830 = .83 or 83%
Neither: 20/35= .570 = .57 or 57%
Total: 125/150 = .830 = .83 or 83
69

Appendix SRA-A.C: Major Depressive Disorder (MDD): Suicide Risk Assessment

Measure interpretation: For the Medicaid consumers aged 18 years and older with a
diagnosis of Major Depressive Disorder (MDD), 94% had a suicide risk assessment
completed during the visit in which a new diagnosis or recurrent episode was identified.
In contrast, for those consumers without Medicare or Medicaid (defined as “Neither”),
only 57% had a suicide risk assessment completed during the same visit.

70

Appendix CDF-BH.A: Screening for Clinical Depression and Follow-Up Plan

Appendix CDF-BH.A: Screening for Clinical Depression and Follow-Up Plan
Percentage of consumers aged 12 years and older screened for clinical depression on the
date of the encounter using an age-appropriate standardized depression screening tool,
and if positive, a follow-up plan is documented on the date of the positive screen
EXAMPLE
Eligible Population or Denominator: Calculate the denominator as follows, with the
measurement period (MP) being the measurement year (MY):
1. Consumers seen at the clinic who were aged 12 years or older on the date of first
denominator eligible visit during the MY: 400
2. Of the 400 consumers, 250 are Medicaid beneficiaries, 100 are beneficiaries of
both Medicare and Medicaid, and 50 are neither.
3. Consumers excluded due to active diagnosis of Depression or Bipolar Disorder:
20; due to refusal to participate: 15; due to emergency: 20; due to functional
capacity or motivation: 15. Total: 70.
Calculate as follows:
Steps in calculation
Age and outpatient
encounter-eligible
consumers seen during MY
Exclusions
Denominator

Medicaid

Medicare &
Medicaid

Neither

Total

250

100

50

400

45

15

10

70

205

85

40

330

Numerator: Calculate the numerator as follows, with the MP being the measurement
year:
Positive screen for clinical depression using a standardized tool and a follow-up
plan documented (G8431).

71

Appendix CDF-BH.A: Screening for Clinical Depression and Follow-Up Plan

Steps in calculation

Medicaid

Medicare &
Medicaid

Neither

Total

Denominator

205

85

40

330

Consumers screened for
clinical depression with
positive screen

100

55

5

160

Consumers with positive
screen who had a follow-up
plan documented on the
same day

90

30

3

123

Numerator

90

30

3

123

Quality Measure, percentage of consumers aged 12 years and older screened for
clinical depression on the date of the encounter using an age-appropriate standardized
depression screening tool, and if positive, a follow-up plan is documented on the date
of the positive screen, by payer status:
Medicaid: 90/205 = .44 or 44%
Medicare & Medicaid: 30/85 = .35 or 35%
Neither: 3/40 = .08 or 8%
Total: 123/330 = .37 or 37%
Metrics interpretation: For the Medicaid eligible population, 44% of consumers were screened
and had a positive result for clinical depression and were also documented with a follow-up plan
on the same date as the screening; whereas, 35% with both Medicare and Medicaid and 8%
without Medicare or Medicaid (referred to as “Neither”) were both screened and positive for
clinical depression and were documented to have a follow-up plan put in place on the same day.
See below for similar calculation stratified by age:

72

Appendix CDF-BH.A: Screening for Clinical Depression and Follow-Up Plan

Denominator:
Steps in calculation
Age and outpatient
encounter-eligible
consumers seen during
MY

Aged 12-17 years Aged 18-64 years Aged 65 years and older

Total

100

225

75

400

Exclusions

20

40

10

70

Denominator

80

185

65

330

Numerator:
Steps in calculation

Aged 12-17 years

Aged 18-64 years

Aged 65 years and
older

Total

Denominator

80

185

65

330

Consumers screened
for clinical depression
with positive screen

65

170

35

270

Consumers with
positive screen who
had a follow-up plan
documented on the
same day

40

63

20

123

Numerator

40

63

20

123

Quality Metric, percentage of consumers aged 12 years and older screened for clinical
depression on the date of the encounter using an age-appropriate standardized
depression screening tool, and if positive, a follow-up plan is documented on the date
of the positive screen, by age category:
Aged 12-17: 40/80 = .50 or 50%
Aged 18-64: 63/185 = .34 or 34%
Aged 65 and older: 20/65 = .31 or 31%
Total: 123/330 = .37 or 37%

73

Appendix CDF-BH.A: Screening for Clinical Depression and Follow-Up Plan

Metrics interpretation: For those consumers in the eligible population aged 65 years and older,
31% who were screened and had a positive result for clinical depression were also documented
with a follow-up plan on the same date as the screening; whereas, 34% of consumers aged 18 to
64 years and 50% of those aged 12 to 17 years had a positive clinical depression screen and
follow-up plan was needed.

74

Appendix CDF-BH.B: Screening for Clinical Depression and Follow-Up Plan

Appendix CDF-BH.B: Screening for Clinical Depression and Follow-Up Plan
Table CDF-A. Codes to Identify Outpatient Visits
CPT

HCPCS

90791, 90792, 90832, 90834, 90837, 90839, 92625,
96116, 96118, 96150, 96151, 97003, 99201, 99202,
99203, 99204, 99205, 99212, 99213, 99214, 99215

G0101, G0402, G0438,
G0439, G0444

Table CDF-B. Codes to Document Clinical Depression Screen
Code

Description

G8431

Positive screen for clinical depression using a standardized tool and a
follow-up plan documented.

G8510

Negative screen for clinical depression using standardized tool, patient not
eligible/appropriate for follow-up plan documented.

Table CDF-C. Codes to Identify Exclusions
Code

Description

G8433

Screening for clinical depression not documented, patient not
eligible/appropriate.

G8940

Screening for clinical depression documented, follow-up plan not
documented, patient not eligible/appropriate.

Depression F320, F321, F322, F323, F324, F325, F328, F329, F330, F331, F332,
F333, F3340, F3341, F3342, F338, F339, F341
Bipolar
Disorder

F310, F3110, F3111, F3112, F3113, F312, F3130, F3131, F3132, F314,
F315, F3160, F3161, F3162, F3163, F3164, F3170, F3171, F3172, F3173,
F3174, F3175, F3176, F3177, F3178, F3181, F3189, F319, F3010, F3011,
F3012, F3013, F302, F303, F304, F308, F309

75

Appendix DEP-REM-12. Depression Remission at Twelve Months

Appendix DEP-REM-12. Depression Remission at Twelve Months
Adult consumers age 18 and older with Major Depression or Dysthymia and an initial
PHQ-9 score > 9 who demonstrate remission at twelve months defined as a PHQ-9 score
less than 5
EXAMPLE
Eligible Population or Denominator:
1. 200 consumers seen at the clinic during the measurement year (MY)
2. Exclusions:
a. Died during MY: 10
b. Were in hospice during MY: 5
c. Became permanent nursing home resident during MY: 0
d. Had a diagnosis of bipolar disorder: 30
e. Had a diagnosis of personality disorder: 15
Sum of a. – e. = 10+5+0+30+15=60
200-60=140 nonexcluded patients
3. Of the 140 nonexcluded consumers, 100 were Medicaid beneficiaries and 20 were
eligible for both Medicare and Medicaid, and 20 were neither.
4. Compute the rest of the denominator (N=140) as follows:
Steps in calculation

Medicaid

Medicare &
Medicaid

Neither

Total

Nonexcluded consumers seen
during the MY

100

20

20

140

From those, consumers whose
PHQ-9 score was greater than
9 (at the index date) during the
MY

75

20

10

105

76

Appendix DEP-REM-12. Depression Remission at Twelve Months

Steps in calculation

Medicaid

Medicare &
Medicaid

Neither

Total

From those, consumers with a
primary9 diagnosis of Major
Depression or Dysthymia upon
scoring greater than 9 on the
PHQ-9 at the index date

55

20

5

80

From those, consumers aged
18 years and older on the
index date when they had a
PHQ-9 score greater than 9

40

15

5

60

Denominator

40

15

5

60

Numerator: Twelve months after the index date (± 30 days), scored less than 5 on the
PHQ-9:
Steps in calculation

Medicaid

Eligible consumers after
exclusions

Medicare &
Medicaid

Neither

Total

40

15

5

60

Not administered PHQ-9
during the 60 day window of
twelve months

4

2

1

7

Tested during the 60 day
window but scored 5 or higher
on the PHQ-9

7

3

1

11

40-11=29

15-5=10

5-2=3

60-18=42

Numerator

Quality Measure, percentage with 12-month depression remission:
Medicaid: 29/40 = .725 = .73 or 73%
Medicare and Medicaid: 10/15 = .666 = .67 or 67%
Neither: 3/5 = .60 = .60 or 60%
9

Note that if the diagnosis and score greater than 9 was provided by a non-behavioral health provider, the diagnosis
can be in any position.

77

Appendix DEP-REM-12. Depression Remission at Twelve Months

Total: 42/60 = .70 = .70 or 70%
Measure interpretation: Of the Medicaid consumers in the eligible population aged 18
years and older with Major Depression or Dysthymia and an initial PHQ-9 score > 9,
73% demonstrated remission at twelve months defined as a PHQ-9 score less than 5.

78

Appendix HOU: Housing Status

Appendix HOU: Housing Status
Percentage of consumers in 10 categories of living situation
EXAMPLE
Assuming 100 consumers during the first half of the measurement year (MY) and 120 consumers
during the second half of the MY, calculate this metric as follows:
Living Situation

First Half of
MY (N)
45

First Half of
MY (%)
45%

Second Half
of MY (N)
49

Second Half
of MY (%)
41%

Foster home

8

8%

16

13%

Residential care

4

4%

6

5%

Crisis residence

3

3%

4

3%

Residential treatment center

5

5%

5

4%

Institutional setting

7

7%

6

5%

Jail (correctional facility)

9

9%

9

8%

Homeless (shelter)

15

15%

12

10%

Other

3

3%

2

2%

Not available

1

1%

11

9%

100

100%

120

100%

Private residence

Total

Note: Some portion of these assessments will be made at admissions or discharges, and the
remainder will be made at the most recent assessment or indication of living situation for the
consumer during the measurement period.

79

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM)
codes that may apply to suicide attempts include those pertaining to drug overdoses (designated
as “poisonings”), to ingestion of non-drugs (classified as poisoning with a toxic effect), and to
other self-inflicted injuries. In addition, codes related to suicidal ideation and suicide attempt are
available. Each category is provided below.
Drug Overdose. Unlike ICD-9-CM codes, ICD-10-CM codes for poisoning by drug overdose
include both the drug poisoning and the circumstances of the poisoning (accidental, intentional,
assault, and undetermined). These ICD-10-CM codes are included in code categories T36–T50,
with the codes related to intentional overdose listed in Table 1 below.
Table 1. Suicide Attempt by Intentional Drug Overdose Codes
Code
Poisoning by Overdose
T360X2A

Poisoning by penicillins, intentional self-harm, initial encounter

T360X2D

Poisoning by penicillins, intentional self-harm, subsequent encounter

T360X2S

Poisoning by penicillins, intentional self-harm, sequela

T361X2A

Poisoning by cephalosporins and other beta-lactam antibiotics, intentional selfharm, initial encounter

T361X2D

Poisoning by cephalosporins and other beta-lactam antibiotics, intentional selfharm, subsequent encounter

T361X2S

Poisoning by cephalosporins and other beta-lactam antibiotics, intentional selfharm, sequela

T362X2A

Poisoning by chloramphenicol group, intentional self-harm, initial encounter

T362X2D

Poisoning by chloramphenicol group, intentional self-harm, subsequent
encounter

T362X2S

Poisoning by chloramphenicol group, intentional self-harm, sequela

T363X2A

Poisoning by macrolides, intentional self-harm, initial encounter

T363X2D

Poisoning by macrolides, intentional self-harm, subsequent encounter

T363X2S

Poisoning by macrolides, intentional self-harm, sequela

T364X2A

Poisoning by tetracyclines, intentional self-harm, initial encounter

T364X2D

Poisoning by tetracyclines, intentional self-harm, subsequent encounter
80

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T364X2S

Poisoning by tetracyclines, intentional self-harm, sequela

T365X2A

Poisoning by aminoglycosides, intentional self-harm, initial encounter

T365X2D

Poisoning by aminoglycosides, intentional self-harm, subsequent encounter

T365X2S

Poisoning by aminoglycosides, intentional self-harm, sequela

T366X2A

Poisoning by rifampicins, intentional self-harm, initial encounter

T366X2D

Poisoning by rifampicins, intentional self-harm, subsequent encounter

T366X2S

Poisoning by rifampicins, intentional self-harm, sequela

T367X2A

Poisoning by antifungal antibiotics, systemically used, intentional self-harm,
initial encounter

T367X2D

Poisoning by antifungal antibiotics, systemically used, intentional self-harm,
subsequent encounter

T367X2S

Poisoning by antifungal antibiotics, systemically used, intentional self-harm,
sequela

T368X2A

Poisoning by other systemic antibiotics, intentional self-harm, initial encounter

T368X2D

Poisoning by other systemic antibiotics, intentional self-harm, subsequent
encounter

T368X2S

Poisoning by other systemic antibiotics, intentional self-harm, sequela

T3692XA

Poisoning by unspecified systemic antibiotic, intentional self-harm, initial
encounter

T3692XD

Poisoning by unspecified systemic antibiotic, intentional self-harm, subsequent
encounter

T3692XS

Poisoning by unspecified systemic antibiotic, intentional self-harm, sequela

T370X2A

Poisoning by sulfonamides, intentional self-harm, initial encounter

T370X2D

Poisoning by sulfonamides, intentional self-harm, subsequent encounter

T370X2S

Poisoning by sulfonamides, intentional self-harm, sequela

T371X2A

Poisoning by antimycobacterial drugs, intentional self-harm, initial encounter

T371X2D

Poisoning by antimycobacterial drugs, intentional self-harm, subsequent
encounter
81

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T371X2S

Poisoning by antimycobacterial drugs, intentional self-harm, sequela

T372X2A

Poisoning by antimalarials and drugs acting on other blood protozoa, intentional
self-harm, initial encounter

T372X2D

Poisoning by antimalarials and drugs acting on other blood protozoa, intentional
self-harm, subsequent encounter

T372X2S

Poisoning by antimalarials and drugs acting on other blood protozoa, intentional
self-harm, sequela

T374X2A

Poisoning by anthelminthics, intentional self-harm, initial encounter

T374X2D

Poisoning by anthelminthics, intentional self-harm, subsequent encounter

T374X2S

Poisoning by anthelminthics, intentional self-harm, sequela

T375X2A

Poisoning by antiviral drugs, intentional self-harm, initial encounter

T375X2D

Poisoning by antiviral drugs, intentional self-harm, subsequent encounter

T375X2S

Poisoning by antiviral drugs, intentional self-harm, sequela

T378X2A

Poisoning by other specified systemic anti-infectives and antiparasitics,
intentional self-harm, initial encounter

T378X2D

Poisoning by other specified systemic anti-infectives and antiparasitics,
intentional self-harm, subsequent encounter

T378X2S

Poisoning by other specified systemic anti-infectives and antiparasitics,
intentional self-harm, sequela

T3792XA

Poisoning by unspecified systemic anti-infective and antiparasitics, intentional
self-harm, initial encounter

T3792XD

Poisoning by unspecified systemic anti-infective and antiparasitics, intentional
self-harm, subsequent encounter

T3792XS

Poisoning by unspecified systemic anti-infective and antiparasitics, intentional
self-harm, sequela

T380X2A

Poisoning by glucocorticoids and synthetic analogues, intentional self-harm,
initial encounter

T380X2D

Poisoning by glucocorticoids and synthetic analogues, intentional self-harm,
subsequent encounter

82

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T380X2S

Poisoning by glucocorticoids and synthetic analogues, intentional self-harm,
sequela

T381X2A

Poisoning by thyroid hormones and substitutes, intentional self-harm, initial
encounter

T381X2D

Poisoning by thyroid hormones and substitutes, intentional self-harm,
subsequent encounter

T381X2S

Poisoning by thyroid hormones and substitutes, intentional self-harm, sequela

T382X2A

Poisoning by antithyroid drugs, intentional self-harm, initial encounter

T382X2D

Poisoning by antithyroid drugs, intentional self-harm, subsequent encounter

T382X2S

Poisoning by antithyroid drugs, intentional self-harm, sequela

T383X2A

Poisoning by insulin and oral hypoglycemic [antidiabetic] drugs, intentional selfharm, initial encounter

T383X2D

Poisoning by insulin and oral hypoglycemic [antidiabetic] drugs, intentional selfharm, subsequent encounter

T383X2S

Poisoning by insulin and oral hypoglycemic [antidiabetic] drugs, intentional selfharm, sequela

T384X2A

Poisoning by oral contraceptives, intentional self-harm, initial encounter

T384X2D

Poisoning by oral contraceptives, intentional self-harm, subsequent encounter

T384X2S

Poisoning by oral contraceptives, intentional self-harm, sequela

T385X2A

Poisoning by other estrogens and progestogens, intentional self-harm, initial
encounter

T385X2D

Poisoning by other estrogens and progestogens, intentional self-harm,
subsequent encounter

T385X2S

Poisoning by other estrogens and progestogens, intentional self-harm, sequela

T386X2A

Poisoning by antigonadotrophins, antiestrogens, antiandrogens, not elsewhere
classified, intentional self-harm, initial encounter

T386X2D

Poisoning by antigonadotrophins, antiestrogens, antiandrogens, not elsewhere
classified, intentional self-harm, subsequent encounter

83

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T386X2S

Poisoning by antigonadotrophins, antiestrogens, antiandrogens, not elsewhere
classified, intentional self-harm, sequela

T387X2A

Poisoning by androgens and anabolic congeners, intentional self-harm, initial
encounter

T387X2D

Poisoning by androgens and anabolic congeners, intentional self-harm,
subsequent encounter

T387X2S

Poisoning by androgens and anabolic congeners, intentional self-harm, sequela

T38802A

Poisoning by unspecified hormones and synthetic substitutes, intentional selfharm, initial encounter

T38802D

Poisoning by unspecified hormones and synthetic substitutes, intentional selfharm, subsequent encounter

T38802S

Poisoning by unspecified hormones and synthetic substitutes, intentional selfharm, sequela

T38812A

Poisoning by anterior pituitary [adenohypophyseal] hormones, intentional selfharm, initial encounter

T38812D

Poisoning by anterior pituitary [adenohypophyseal] hormones, intentional selfharm, subsequent encounter

T38812S

Poisoning by anterior pituitary [adenohypophyseal] hormones, intentional selfharm, sequela

T38892A

Poisoning by other hormones and synthetic substitutes, intentional self-harm,
initial encounter

T38892D

Poisoning by other hormones and synthetic substitutes, intentional self-harm,
subsequent encounter

T38892S

Poisoning by other hormones and synthetic substitutes, intentional self-harm,
sequela

T38902A

Poisoning by unspecified hormone antagonists, intentional self-harm, initial
encounter

T38902D

Poisoning by unspecified hormone antagonists, intentional self-harm, subsequent
encounter

T38902S

Poisoning by unspecified hormone antagonists, intentional self-harm, sequela

84

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T38992A

Poisoning by other hormone antagonists, intentional self-harm, initial encounter

T38992D

Poisoning by other hormone antagonists, intentional self-harm, subsequent
encounter

T38992S

Poisoning by other hormone antagonists, intentional self-harm, sequela

T39012A

Poisoning by aspirin, intentional self-harm, initial encounter

T39012D

Poisoning by aspirin, intentional self-harm, subsequent encounter

T39012S

Poisoning by aspirin, intentional self-harm, sequela

T39092A

Poisoning by salicylates, intentional self-harm, initial encounter

T39092D

Poisoning by salicylates, intentional self-harm, subsequent encounter

T39092S

Poisoning by salicylates, intentional self-harm, sequela

T391X2A

Poisoning by 4-Aminophenol derivatives, intentional self-harm, initial encounter

T391X2D

Poisoning by 4-Aminophenol derivatives, intentional self-harm, subsequent
encounter

T391X2S

Poisoning by 4-Aminophenol derivatives, intentional self-harm, sequela

T392X2A

Poisoning by pyrazolone derivatives, intentional self-harm, initial encounter

T392X2D

Poisoning by pyrazolone derivatives, intentional self-harm, subsequent
encounter

T392X2S

Poisoning by pyrazolone derivatives, intentional self-harm, sequela

T39312A

Poisoning by propionic acid derivatives, intentional self-harm, initial encounter

T39312D

Poisoning by propionic acid derivatives, intentional self-harm, subsequent
encounter

T39312S

Poisoning by propionic acid derivatives, intentional self-harm, sequela

T39392A

Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], intentional
self-harm, initial encounter

T39392D

Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], intentional
self-harm, subsequent encounter

T39392S

Poisoning by other nonsteroidal anti-inflammatory drugs [NSAID], intentional
self-harm, sequela
85

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T394X2A

Poisoning by antirheumatics, not elsewhere classified, intentional self-harm,
initial encounter

T394X2D

Poisoning by antirheumatics, not elsewhere classified, intentional self-harm,
subsequent encounter

T394X2S

Poisoning by antirheumatics, not elsewhere classified, intentional self-harm,
sequela

T398X2A

Poisoning by other nonopioid analgesics and antipyretics, not elsewhere
classified, intentional self-harm, initial encounter

T398X2D

Poisoning by other nonopioid analgesics and antipyretics, not elsewhere
classified, intentional self-harm, subsequent encounter

T398X2S

Poisoning by other nonopioid analgesics and antipyretics, not elsewhere
classified, intentional self-harm, sequela

T3992XA

Poisoning by unspecified nonopioid analgesic, antipyretic and antirheumatic,
intentional self-harm, initial encounter

T3992XD

Poisoning by unspecified nonopioid analgesic, antipyretic and antirheumatic,
intentional self-harm, subsequent encounter

T3992XS

Poisoning by unspecified nonopioid analgesic, antipyretic and antirheumatic,
intentional self-harm, sequela

T400X2A

Poisoning by opium, intentional self-harm, initial encounter

T400X2D

Poisoning by opium, intentional self-harm, subsequent encounter

T400X2S

Poisoning by opium, intentional self-harm, sequela

T401X2A

Poisoning by heroin, intentional self-harm, initial encounter

T401X2D

Poisoning by heroin, intentional self-harm, subsequent encounter

T401X2S

Poisoning by heroin, intentional self-harm, sequela

T402X2A

Poisoning by other opioids, intentional self-harm, initial encounter

T402X2D

Poisoning by other opioids, intentional self-harm, subsequent encounter

T402X2S

Poisoning by other opioids, intentional self-harm, sequela

T403X2A

Poisoning by methadone, intentional self-harm, initial encounter

86

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T403X2D

Poisoning by methadone, intentional self-harm, subsequent encounter

T403X2S

Poisoning by methadone, intentional self-harm, sequela

T404X2A

Poisoning by other synthetic narcotics, intentional self-harm, initial encounter

T404X2D

Poisoning by other synthetic narcotics, intentional self-harm, subsequent
encounter

T404X2S

Poisoning by other synthetic narcotics, intentional self-harm, sequela

T405X2A

Poisoning by cocaine, intentional self-harm, initial encounter

T405X2D

Poisoning by cocaine, intentional self-harm, subsequent encounter

T405X2S

Poisoning by cocaine, intentional self-harm, sequela

T40602A

Poisoning by unspecified narcotics, intentional self-harm, initial encounter

T40602D

Poisoning by unspecified narcotics, intentional self-harm, subsequent encounter

T40602S

Poisoning by unspecified narcotics, intentional self-harm, sequela

T40692A

Poisoning by other narcotics, intentional self-harm, initial encounter

T40692D

Poisoning by other narcotics, intentional self-harm, subsequent encounter

T40692S

Poisoning by other narcotics, intentional self-harm, sequela

T407X2A

Poisoning by cannabis (derivatives), intentional self-harm, initial encounter

T407X2D

Poisoning by cannabis (derivatives), intentional self-harm, subsequent encounter

T407X2S

Poisoning by cannabis (derivatives), intentional self-harm, sequela

T408X2A

Poisoning by lysergide [LSD], intentional self-harm, initial encounter

T408X2D

Poisoning by lysergide [LSD], intentional self-harm, subsequent encounter

T408X2S

Poisoning by lysergide [LSD], intentional self-harm, sequela

T40902A

Poisoning by unspecified psychodysleptics [hallucinogens], intentional selfharm, initial encounter

T40902D

Poisoning by unspecified psychodysleptics [hallucinogens], intentional selfharm, subsequent encounter

87

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T40902S

Poisoning by unspecified psychodysleptics [hallucinogens], intentional selfharm, sequela

T40992A

Poisoning by other psychodysleptics [hallucinogens], intentional self-harm,
initial encounter

T40992D

Poisoning by other psychodysleptics [hallucinogens], intentional self-harm,
subsequent encounter

T40992S

Poisoning by other psychodysleptics [hallucinogens], intentional self-harm,
sequela

T410X2A

Poisoning by inhaled anesthetics, intentional self-harm, initial encounter

T410X2D

Poisoning by inhaled anesthetics, intentional self-harm, subsequent encounter

T410X2S

Poisoning by inhaled anesthetics, intentional self-harm, sequela

T411X2A

Poisoning by intravenous anesthetics, intentional self-harm, initial encounter

T411X2D

Poisoning by intravenous anesthetics, intentional self-harm, subsequent
encounter

T411X2S

Poisoning by intravenous anesthetics, intentional self-harm, sequela

T41202A

Poisoning by unspecified general anesthetics, intentional self-harm, initial
encounter

T41202D

Poisoning by unspecified general anesthetics, intentional self-harm, subsequent
encounter

T41202S

Poisoning by unspecified general anesthetics, intentional self-harm, sequela

T41292A

Poisoning by other general anesthetics, intentional self-harm, initial encounter

T41292D

Poisoning by other general anesthetics, intentional self-harm, subsequent
encounter

T41292S

Poisoning by other general anesthetics, intentional self-harm, sequela

T413X2A

Poisoning by local anesthetics, intentional self-harm, initial encounter

T413X2D

Poisoning by local anesthetics, intentional self-harm, subsequent encounter

T413X2S

Poisoning by local anesthetics, intentional self-harm, sequela

T4142XA

Poisoning by unspecified anesthetic, intentional self-harm, initial encounter

88

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T4142XD

Poisoning by unspecified anesthetic, intentional self-harm, subsequent encounter

T4142XS

Poisoning by unspecified anesthetic, intentional self-harm, sequela

T415X2A

Poisoning by therapeutic gases, intentional self-harm, initial encounter

T415X2D

Poisoning by therapeutic gases, intentional self-harm, subsequent encounter

T415X2S

Poisoning by therapeutic gases, intentional self-harm, sequela

T420X2A

Poisoning by hydantoin derivatives, intentional self-harm, initial encounter

T420X2D

Poisoning by hydantoin derivatives, intentional self-harm, subsequent encounter

T420X2S

Poisoning by hydantoin derivatives, intentional self-harm, sequela

T421X2A

Poisoning by iminostilbenes, intentional self-harm, initial encounter

T421X2D

Poisoning by iminostilbenes, intentional self-harm, subsequent encounter

T421X2S

Poisoning by iminostilbenes, intentional self-harm, sequela

T422X2A

Poisoning by succinimides and oxazolidinediones, intentional self-harm, initial
encounter

T422X2D

Poisoning by succinimides and oxazolidinediones, intentional self-harm,
subsequent encounter

T422X2S

Poisoning by succinimides and oxazolidinediones, intentional self-harm, sequela

T423X2A

Poisoning by barbiturates, intentional self-harm, initial encounter

T423X2D

Poisoning by barbiturates, intentional self-harm, subsequent encounter

T423X2S

Poisoning by barbiturates, intentional self-harm, sequela

T424X2A

Poisoning by benzodiazepines, intentional self-harm, initial encounter

T424X2D

Poisoning by benzodiazepines, intentional self-harm, subsequent encounter

T424X2S

Poisoning by benzodiazepines, intentional self-harm, sequela

T425X2A

Poisoning by mixed antiepileptics, intentional self-harm, initial encounter

T425X2D

Poisoning by mixed antiepileptics, intentional self-harm, subsequent encounter

T425X2S

Poisoning by mixed antiepileptics, intentional self-harm, sequela

89

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T426X2A

Poisoning by other antiepileptic and sedative-hypnotic drugs, intentional selfharm, initial encounter

T426X2D

Poisoning by other antiepileptic and sedative-hypnotic drugs, intentional selfharm, subsequent encounter

T426X2S

Poisoning by other antiepileptic and sedative-hypnotic drugs, intentional selfharm, sequela

T4272XA

Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, intentional
self-harm, initial encounter

T4272XD

Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, intentional
self-harm, subsequent encounter

T4272XS

Poisoning by unspecified antiepileptic and sedative-hypnotic drugs, intentional
self-harm, sequela

T428X2A

Poisoning by antiparkinsonism drugs and other central muscle-tone depressants,
intentional self-harm, initial encounter

T428X2D

Poisoning by antiparkinsonism drugs and other central muscle-tone depressants,
intentional self-harm, subsequent encounter

T428X2S

Poisoning by antiparkinsonism drugs and other central muscle-tone depressants,
intentional self-harm, sequela

T43012A

Poisoning by tricyclic antidepressants, intentional self-harm, initial encounter

T43012D

Poisoning by tricyclic antidepressants, intentional self-harm, subsequent
encounter

T43012S

Poisoning by tricyclic antidepressants, intentional self-harm, sequela

T43022A

Poisoning by tetracyclic antidepressants, intentional self-harm, initial encounter

T43022D

Poisoning by tetracyclic antidepressants, intentional self-harm, subsequent
encounter

T43022S

Poisoning by tetracyclic antidepressants, intentional self-harm, sequela

T431X2A

Poisoning by monoamine-oxidase-inhibitor antidepressants, intentional selfharm, initial encounter

T431X2D

Poisoning by monoamine-oxidase-inhibitor antidepressants, intentional selfharm, subsequent encounter
90

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T431X2S

Poisoning by monoamine-oxidase-inhibitor antidepressants, intentional selfharm, sequela

T43202A

Poisoning by unspecified antidepressants, intentional self-harm, initial encounter

T43202D

Poisoning by unspecified antidepressants, intentional self-harm, subsequent
encounter

T43202S

Poisoning by unspecified antidepressants, intentional self-harm, sequela

T43212A

Poisoning by selective serotonin and norepinephrine reuptake inhibitors,
intentional self-harm, initial encounter

T43212D

Poisoning by selective serotonin and norepinephrine reuptake inhibitors,
intentional self-harm, subsequent encounter

T43212S

Poisoning by selective serotonin and norepinephrine reuptake inhibitors,
intentional self-harm, sequela

T43222A

Poisoning by selective serotonin reuptake inhibitors, intentional self-harm, initial
encounter

T43222D

Poisoning by selective serotonin reuptake inhibitors, intentional self-harm,
subsequent encounter

T43222S

Poisoning by selective serotonin reuptake inhibitors, intentional self-harm,
sequela

T43292A

Poisoning by other antidepressants, intentional self-harm, initial encounter

T43292D

Poisoning by other antidepressants, intentional self-harm, subsequent encounter

T43292S

Poisoning by other antidepressants, intentional self-harm, sequela

T43592A

Poisoning by other antipsychotics and neuroleptics, intentional self-harm, initial
encounter

T43592D

Poisoning by other antipsychotics and neuroleptics, intentional self-harm,
subsequent encounter

T43592S

Poisoning by other antipsychotics and neuroleptics, intentional self-harm,
sequela

T43602A

Poisoning by unspecified psychostimulants, intentional self-harm, initial
encounter

91

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T43602D

Poisoning by unspecified psychostimulants, intentional self-harm, subsequent
encounter

T43602S

Poisoning by unspecified psychostimulants, intentional self-harm, sequela

T43612A

Poisoning by caffeine, intentional self-harm, initial encounter

T43612D

Poisoning by caffeine, intentional self-harm, subsequent encounter

T43612S

Poisoning by caffeine, intentional self-harm, sequela

T43613A

Poisoning by caffeine, assault, initial encounter

T43622A

Poisoning by amphetamines, intentional self-harm, initial encounter

T43622D

Poisoning by amphetamines, intentional self-harm, subsequent encounter

T43622S

Poisoning by amphetamines, intentional self-harm, sequela

T43632A

Poisoning by methylphenidate, intentional self-harm, initial encounter

T43632D

Poisoning by methylphenidate, intentional self-harm, subsequent encounter

T43632S

Poisoning by methylphenidate, intentional self-harm, sequela

T43692A

Poisoning by other psychostimulants, intentional self-harm, initial encounter

T43692D

Poisoning by other psychostimulants, intentional self-harm, subsequent
encounter

T43692S

Poisoning by other psychostimulants, intentional self-harm, sequela

T438X2A

Poisoning by other psychotropic drugs, intentional self-harm, initial encounter

T438X2D

Poisoning by other psychotropic drugs, intentional self-harm, subsequent
encounter

T438X2S

Poisoning by other psychotropic drugs, intentional self-harm, sequela

T4392XA

Poisoning by unspecified psychotropic drug, intentional self-harm, initial
encounter

T4392XD

Poisoning by unspecified psychotropic drug, intentional self-harm, subsequent
encounter

T4392XS

Poisoning by unspecified psychotropic drug, intentional self-harm, sequela

T440X2A

Poisoning by anticholinesterase agents, intentional self-harm, initial encounter

92

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T440X2D

Poisoning by anticholinesterase agents, intentional self-harm, subsequent
encounter

T440X2S

Poisoning by anticholinesterase agents, intentional self-harm, sequela

T441X2A

Poisoning by other parasympathomimetics [cholinergics], intentional self-harm,
initial encounter

T441X2D

Poisoning by other parasympathomimetics [cholinergics], intentional self-harm,
subsequent encounter

T441X2S

Poisoning by other parasympathomimetics [cholinergics], intentional self-harm,
sequela

T442X2A

Poisoning by ganglionic blocking drugs, intentional self-harm, initial encounter

T442X2D

Poisoning by ganglionic blocking drugs, intentional self-harm, subsequent
encounter

T442X2S

Poisoning by ganglionic blocking drugs, intentional self-harm, sequela

T443X2A

Poisoning by other parasympatholytics [anticholinergics and antimuscarinics]
and spasmolytics, intentional self-harm, initial encounter

T443X2D

Poisoning by other parasympatholytics [anticholinergics and antimuscarinics]
and spasmolytics, intentional self-harm, subsequent encounter

T443X2S

Poisoning by other parasympatholytics [anticholinergics and antimuscarinics]
and spasmolytics, intentional self-harm, sequela

T444X2A

Poisoning by predominantly alpha-adrenoreceptor agonists, intentional selfharm, initial encounter

T444X2D

Poisoning by predominantly alpha-adrenoreceptor agonists, intentional selfharm, subsequent encounter

T444X2S

Poisoning by predominantly alpha-adrenoreceptor agonists, intentional selfharm, sequela

T445X2A

Poisoning by predominantly beta-adrenoreceptor agonists, intentional self-harm,
initial encounter

T445X2D

Poisoning by predominantly beta-adrenoreceptor agonists, intentional self-harm,
subsequent encounter

93

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T445X2S

Poisoning by predominantly beta-adrenoreceptor agonists, intentional self-harm,
sequela

T446X2A

Poisoning by alpha-adrenoreceptor antagonists, intentional self-harm, initial
encounter

T446X2D

Poisoning by alpha-adrenoreceptor antagonists, intentional self-harm, subsequent
encounter

T446X2S

Poisoning by alpha-adrenoreceptor antagonists, intentional self-harm, sequela

T447X2A

Poisoning by beta-adrenoreceptor antagonists, intentional self-harm, initial
encounter

T447X2D

Poisoning by beta-adrenoreceptor antagonists, intentional self-harm, subsequent
encounter

T447X2S

Poisoning by beta-adrenoreceptor antagonists, intentional self-harm, sequela

T448X2A

Poisoning by centrally-acting and adrenergic-neuron-blocking agents, intentional
self-harm, initial encounter

T448X2D

Poisoning by centrally-acting and adrenergic-neuron-blocking agents, intentional
self-harm, subsequent encounter

T448X2S

Poisoning by centrally-acting and adrenergic-neuron-blocking agents, intentional
self-harm, sequela

T44902A

Poisoning by unspecified drugs primarily affecting the autonomic nervous
system, intentional self-harm, initial encounter

T44902D

Poisoning by unspecified drugs primarily affecting the autonomic nervous
system, intentional self-harm, subsequent encounter

T44902S

Poisoning by unspecified drugs primarily affecting the autonomic nervous
system, intentional self-harm, sequela

T44992A

Poisoning by other drug primarily affecting the autonomic nervous system,
intentional self-harm, initial encounter

T44992D

Poisoning by other drug primarily affecting the autonomic nervous system,
intentional self-harm, subsequent encounter

T44992S

Poisoning by other drug primarily affecting the autonomic nervous system,
intentional self-harm, sequela

94

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T450X2A

Poisoning by antiallergic and antiemetic drugs, intentional self-harm, initial
encounter

T450X2D

Poisoning by antiallergic and antiemetic drugs, intentional self-harm, subsequent
encounter

T450X2S

Poisoning by antiallergic and antiemetic drugs, intentional self-harm, sequela

T451X2A

Poisoning by antineoplastic and immunosuppressive drugs, intentional selfharm, initial encounter

T451X2D

Poisoning by antineoplastic and immunosuppressive drugs, intentional selfharm, subsequent encounter

T451X2S

Poisoning by antineoplastic and immunosuppressive drugs, intentional selfharm, sequela

T452X2A

Poisoning by vitamins, intentional self-harm, initial encounter

T452X2D

Poisoning by vitamins, intentional self-harm, subsequent encounter

T452X2S

Poisoning by vitamins, intentional self-harm, sequela

T453X2A

Poisoning by enzymes, intentional self-harm, initial encounter

T453X2D

Poisoning by enzymes, intentional self-harm, subsequent encounter

T453X2S

Poisoning by enzymes, intentional self-harm, sequela

T454X2A

Poisoning by iron and its compounds, intentional self-harm, initial encounter

T454X2D

Poisoning by iron and its compounds, intentional self-harm, subsequent
encounter

T454X2S

Poisoning by iron and its compounds, intentional self-harm, sequela

T45512A

Poisoning by anticoagulants, intentional self-harm, initial encounter

T45512D

Poisoning by anticoagulants, intentional self-harm, subsequent encounter

T45512S

Poisoning by anticoagulants, intentional self-harm, sequela

T45522A

Poisoning by antithrombotic drugs, intentional self-harm, initial encounter

T45522D

Poisoning by antithrombotic drugs, intentional self-harm, subsequent encounter

T45522S

Poisoning by antithrombotic drugs, intentional self-harm, sequela

95

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T45602A

Poisoning by unspecified fibrinolysis-affecting drugs, intentional self-harm,
initial encounter

T45602D

Poisoning by unspecified fibrinolysis-affecting drugs, intentional self-harm,
subsequent encounter

T45602S

Poisoning by unspecified fibrinolysis-affecting drugs, intentional self-harm,
sequela

T45612A

Poisoning by thrombolytic drug, intentional self-harm, initial encounter

T45612D

Poisoning by thrombolytic drug, intentional self-harm, subsequent encounter

T45612S

Poisoning by thrombolytic drug, intentional self-harm, sequela

T45622A

Poisoning by hemostatic drug, intentional self-harm, initial encounter

T45622D

Poisoning by hemostatic drug, intentional self-harm, subsequent encounter

T45622S

Poisoning by hemostatic drug, intentional self-harm, sequela

T45692A

Poisoning by other fibrinolysis-affecting drugs, intentional self-harm, initial
encounter

T45692D

Poisoning by other fibrinolysis-affecting drugs, intentional self-harm, subsequent
encounter

T45692S

Poisoning by other fibrinolysis-affecting drugs, intentional self-harm, sequela

T457X2A

Poisoning by anticoagulant antagonists, vitamin K and other coagulants,
intentional self-harm, initial encounter

T457X2D

Poisoning by anticoagulant antagonists, vitamin K and other coagulants,
intentional self-harm, subsequent encounter

T457X2S

Poisoning by anticoagulant antagonists, vitamin K and other coagulants,
intentional self-harm, sequela

T458X2A

Poisoning by other primarily systemic and hematological agents, intentional selfharm, initial encounter

T458X2D

Poisoning by other primarily systemic and hematological agents, intentional selfharm, subsequent encounter

T458X2S

Poisoning by other primarily systemic and hematological agents, intentional selfharm, sequela

96

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T4592XA

Poisoning by unspecified primarily systemic and hematological agent,
intentional self-harm, initial encounter

T4592XD

Poisoning by unspecified primarily systemic and hematological agent,
intentional self-harm, subsequent encounter

T4592XS

Poisoning by unspecified primarily systemic and hematological agent,
intentional self-harm, sequela

T460X2A

Poisoning by cardiac-stimulant glycosides and drugs of similar action,
intentional self-harm, initial encounter

T460X2D

Poisoning by cardiac-stimulant glycosides and drugs of similar action,
intentional self-harm, subsequent encounter

T460X2S

Poisoning by cardiac-stimulant glycosides and drugs of similar action,
intentional self-harm, sequela

T461X2A

Poisoning by calcium-channel blockers, intentional self-harm, initial encounter

T461X2D

Poisoning by calcium-channel blockers, intentional self-harm, subsequent
encounter

T461X2S

Poisoning by calcium-channel blockers, intentional self-harm, sequela

T462X2A

Poisoning by other antidysrhythmic drugs, intentional self-harm, initial
encounter

T462X2D

Poisoning by other antidysrhythmic drugs, intentional self-harm, subsequent
encounter

T462X2S

Poisoning by other antidysrhythmic drugs, intentional self-harm, sequela

T463X2A

Poisoning by coronary vasodilators, intentional self-harm, initial encounter

T463X2D

Poisoning by coronary vasodilators, intentional self-harm, subsequent encounter

T463X2S

Poisoning by coronary vasodilators, intentional self-harm, sequela

T464X2A

Poisoning by angiotensin-converting-enzyme inhibitors, intentional self-harm,
initial encounter

T464X2D

Poisoning by angiotensin-converting-enzyme inhibitors, intentional self-harm,
subsequent encounter

97

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T464X2S

Poisoning by angiotensin-converting-enzyme inhibitors, intentional self-harm,
sequela

T465X2A

Poisoning by other antihypertensive drugs, intentional self-harm, initial
encounter

T465X2D

Poisoning by other antihypertensive drugs, intentional self-harm, subsequent
encounter

T465X2S

Poisoning by other antihypertensive drugs, intentional self-harm, sequela

T466X2A

Poisoning by antihyperlipidemic and antiarteriosclerotic drugs, intentional selfharm, initial encounter

T466X2D

Poisoning by antihyperlipidemic and antiarteriosclerotic drugs, intentional selfharm, subsequent encounter

T466X2S

Poisoning by antihyperlipidemic and antiarteriosclerotic drugs, intentional selfharm, sequela

T467X2A

Poisoning by peripheral vasodilators, intentional self-harm, initial encounter

T467X2D

Poisoning by peripheral vasodilators, intentional self-harm, subsequent
encounter

T467X2S

Poisoning by peripheral vasodilators, intentional self-harm, sequela

T468X2A

Poisoning by antivaricose drugs, including sclerosing agents, intentional selfharm, initial encounter

T468X2D

Poisoning by antivaricose drugs, including sclerosing agents, intentional selfharm, subsequent encounter

T468X2S

Poisoning by antivaricose drugs, including sclerosing agents, intentional selfharm, sequela

T46902A

Poisoning by unspecified agents primarily affecting the cardiovascular system,
intentional self-harm, initial encounter

T46902D

Poisoning by unspecified agents primarily affecting the cardiovascular system,
intentional self-harm, subsequent encounter

T46902S

Poisoning by unspecified agents primarily affecting the cardiovascular system,
intentional self-harm, sequela

98

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T46992A

Poisoning by other agents primarily affecting the cardiovascular system,
intentional self-harm, initial encounter

T46992D

Poisoning by other agents primarily affecting the cardiovascular system,
intentional self-harm, subsequent encounter

T46992S

Poisoning by other agents primarily affecting the cardiovascular system,
intentional self-harm, sequela

T470X2A

Poisoning by histamine H2-receptor blockers, intentional self-harm, initial
encounter

T470X2D

Poisoning by histamine H2-receptor blockers, intentional self-harm, subsequent
encounter

T470X2S

Poisoning by histamine H2-receptor blockers, intentional self-harm, sequela

T471X2A

Poisoning by other antacids and anti-gastric-secretion drugs, intentional selfharm, initial encounter

T471X2D

Poisoning by other antacids and anti-gastric-secretion drugs, intentional selfharm, subsequent encounter

T471X2S

Poisoning by other antacids and anti-gastric-secretion drugs, intentional selfharm, sequela

T472X2A

Poisoning by stimulant laxatives, intentional self-harm, initial encounter

T472X2D

Poisoning by stimulant laxatives, intentional self-harm, subsequent encounter

T472X2S

Poisoning by stimulant laxatives, intentional self-harm, sequela

T473X2A

Poisoning by saline and osmotic laxatives, intentional self-harm, initial
encounter

T473X2D

Poisoning by saline and osmotic laxatives, intentional self-harm, subsequent
encounter

T473X2S

Poisoning by saline and osmotic laxatives, intentional self-harm, sequela

T474X2A

Poisoning by other laxatives, intentional self-harm, initial encounter

T474X2D

Poisoning by other laxatives, intentional self-harm, subsequent encounter

T474X2S

Poisoning by other laxatives, intentional self-harm, sequela

T475X2A

Poisoning by digestants, intentional self-harm, initial encounter
99

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T475X2D

Poisoning by digestants, intentional self-harm, subsequent encounter

T475X2S

Poisoning by digestants, intentional self-harm, sequela

T476X2A

Poisoning by antidiarrheal drugs, intentional self-harm, initial encounter

T476X2D

Poisoning by antidiarrheal drugs, intentional self-harm, subsequent encounter

T476X2S

Poisoning by antidiarrheal drugs, intentional self-harm, sequela

T477X2A

Poisoning by emetics, intentional self-harm, initial encounter

T477X2D

Poisoning by emetics, intentional self-harm, subsequent encounter

T477X2S

Poisoning by emetics, intentional self-harm, sequela

T478X2A

Poisoning by other agents primarily affecting gastrointestinal system, intentional
self-harm, initial encounter

T478X2D

Poisoning by other agents primarily affecting gastrointestinal system, intentional
self-harm, subsequent encounter

T478X2S

Poisoning by other agents primarily affecting gastrointestinal system, intentional
self-harm, sequela

T4792XA

Poisoning by unspecified agents primarily affecting the gastrointestinal system,
intentional self-harm, initial encounter

T4792XD

Poisoning by unspecified agents primarily affecting the gastrointestinal system,
intentional self-harm, subsequent encounter

T4792XS

Poisoning by unspecified agents primarily affecting the gastrointestinal system,
intentional self-harm, sequela

T480X2A

Poisoning by oxytocic drugs, intentional self-harm, initial encounter

T480X2D

Poisoning by oxytocic drugs, intentional self-harm, subsequent encounter

T480X2S

Poisoning by oxytocic drugs, intentional self-harm, sequela

T481X2A

Poisoning by skeletal muscle relaxants [neuromuscular blocking agents],
intentional self-harm, initial encounter

T481X2D

Poisoning by skeletal muscle relaxants [neuromuscular blocking agents],
intentional self-harm, subsequent encounter

100

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T481X2S

Poisoning by skeletal muscle relaxants [neuromuscular blocking agents],
intentional self-harm, sequela

T48202A

Poisoning by unspecified drugs acting on muscles, intentional self-harm, initial
encounter

T48202D

Poisoning by unspecified drugs acting on muscles, intentional self-harm,
subsequent encounter

T48202S

Poisoning by unspecified drugs acting on muscles, intentional self-harm, sequela

T48292A

Poisoning by other drugs acting on muscles, intentional self-harm, initial
encounter

T48292D

Poisoning by other drugs acting on muscles, intentional self-harm, subsequent
encounter

T48292S

Poisoning by other drugs acting on muscles, intentional self-harm, sequela

T483X2A

Poisoning by antitussives, intentional self-harm, initial encounter

T483X2D

Poisoning by antitussives, intentional self-harm, subsequent encounter

T483X2S

Poisoning by antitussives, intentional self-harm, sequela

T484X2A

Poisoning by expectorants, intentional self-harm, initial encounter

T484X2D

Poisoning by expectorants, intentional self-harm, subsequent encounter

T484X2S

Poisoning by expectorants, intentional self-harm, sequela

T485X2A

Poisoning by other anti-common-cold drugs, intentional self-harm, initial
encounter

T485X2D

Poisoning by other anti-common-cold drugs, intentional self-harm, subsequent
encounter

T485X2S

Poisoning by other anti-common-cold drugs, intentional self-harm, sequela

T486X2A

Poisoning by antiasthmatics, intentional self-harm, initial encounter

T486X2D

Poisoning by antiasthmatics, intentional self-harm, subsequent encounter

T486X2S

Poisoning by antiasthmatics, intentional self-harm, sequela

T48902A

Poisoning by unspecified agents primarily acting on the respiratory system,
intentional self-harm, initial encounter

101

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T48902D

Poisoning by unspecified agents primarily acting on the respiratory system,
intentional self-harm, subsequent encounter

T48902S

Poisoning by unspecified agents primarily acting on the respiratory system,
intentional self-harm, sequela

T48992A

Poisoning by other agents primarily acting on the respiratory system, intentional
self-harm, initial encounter

T48992D

Poisoning by other agents primarily acting on the respiratory system, intentional
self-harm, subsequent encounter

T48992S

Poisoning by other agents primarily acting on the respiratory system, intentional
self-harm, sequela

T490X2A

Poisoning by local antifungal, anti-infective and anti-inflammatory drugs,
intentional self-harm, initial encounter

T490X2D

Poisoning by local antifungal, anti-infective and anti-inflammatory drugs,
intentional self-harm, subsequent encounter

T490X2S

Poisoning by local antifungal, anti-infective and anti-inflammatory drugs,
intentional self-harm, sequela

T491X2A

Poisoning by antipruritics, intentional self-harm, initial encounter

T491X2D

Poisoning by antipruritics, intentional self-harm, subsequent encounter

T491X2S

Poisoning by antipruritics, intentional self-harm, sequela

T492X2A

Poisoning by local astringents and local detergents, intentional self-harm, initial
encounter

T492X2D

Poisoning by local astringents and local detergents, intentional self-harm,
subsequent encounter

T492X2S

Poisoning by local astringents and local detergents, intentional self-harm,
sequela

T493X2A

Poisoning by emollients, demulcents and protectants, intentional self-harm,
initial encounter

T493X2D

Poisoning by emollients, demulcents and protectants, intentional self-harm,
subsequent encounter

102

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T493X2S

Poisoning by emollients, demulcents and protectants, intentional self-harm,
sequela

T494X2A

Poisoning by keratolytics, keratoplastics, and other hair treatment drugs and
preparations, intentional self-harm, initial encounter

T494X2D

Poisoning by keratolytics, keratoplastics, and other hair treatment drugs and
preparations, intentional self-harm, subsequent encounter

T494X2S

Poisoning by keratolytics, keratoplastics, and other hair treatment drugs and
preparations, intentional self-harm, sequela

T495X2A

Poisoning by ophthalmological drugs and preparations, intentional self-harm,
initial encounter

T495X2D

Poisoning by ophthalmological drugs and preparations, intentional self-harm,
subsequent encounter

T495X2S

Poisoning by ophthalmological drugs and preparations, intentional self-harm,
sequela

T496X2A

Poisoning by otorhinolaryngological drugs and preparations, intentional selfharm, initial encounter

T496X2D

Poisoning by otorhinolaryngological drugs and preparations, intentional selfharm, subsequent encounter

T496X2S

Poisoning by otorhinolaryngological drugs and preparations, intentional selfharm, sequela

T497X2A

Poisoning by dental drugs, topically applied, intentional self-harm, initial
encounter

T497X2D

Poisoning by dental drugs, topically applied, intentional self-harm, subsequent
encounter

T497X2S

Poisoning by dental drugs, topically applied, intentional self-harm, sequela

T498X2A

Poisoning by other topical agents, intentional self-harm, initial encounter

T498X2D

Poisoning by other topical agents, intentional self-harm, subsequent encounter

T498X2S

Poisoning by other topical agents, intentional self-harm, sequela

T4992XA

Poisoning by unspecified topical agent, intentional self-harm, initial encounter

103

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T4992XD

Poisoning by unspecified topical agent, intentional self-harm, subsequent
encounter

T4992XS

Poisoning by unspecified topical agent, intentional self-harm, sequela

T500X2A

Poisoning by mineralocorticoids and their antagonists, intentional self-harm,
initial encounter

T500X2D

Poisoning by mineralocorticoids and their antagonists, intentional self-harm,
subsequent encounter

T500X2S

Poisoning by mineralocorticoids and their antagonists, intentional self-harm,
sequela

T501X2A

Poisoning by loop [high-ceiling] diuretics, intentional self-harm, initial
encounter

T501X2D

Poisoning by loop [high-ceiling] diuretics, intentional self-harm, subsequent
encounter

T501X2S

Poisoning by loop [high-ceiling] diuretics, intentional self-harm, sequela

T502X2A

Poisoning by carbonic-anhydrase inhibitors, benzothiadiazides and other
diuretics, intentional self-harm, initial encounter

T502X2D

Poisoning by carbonic-anhydrase inhibitors, benzothiadiazides and other
diuretics, intentional self-harm, subsequent encounter

T502X2S

Poisoning by carbonic-anhydrase inhibitors, benzothiadiazides and other
diuretics, intentional self-harm, sequela

T503X2A

Poisoning by electrolytic, caloric and water-balance agents, intentional selfharm, initial encounter

T503X2D

Poisoning by electrolytic, caloric and water-balance agents, intentional selfharm, subsequent encounter

T503X2S

Poisoning by electrolytic, caloric and water-balance agents, intentional selfharm, sequela

T504X2A

Poisoning by drugs affecting uric acid metabolism, intentional self-harm, initial
encounter

T504X2D

Poisoning by drugs affecting uric acid metabolism, intentional self-harm,
subsequent encounter

104

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T504X2S

Poisoning by drugs affecting uric acid metabolism, intentional self-harm, sequela

T505X2A

Poisoning by appetite depressants, intentional self-harm, initial encounter

T505X2D

Poisoning by appetite depressants, intentional self-harm, subsequent encounter

T505X2S

Poisoning by appetite depressants, intentional self-harm, sequela

T506X2A

Poisoning by antidotes and chelating agents, intentional self-harm, initial
encounter

T506X2D

Poisoning by antidotes and chelating agents, intentional self-harm, subsequent
encounter

T506X2S

Poisoning by antidotes and chelating agents, intentional self-harm, sequela

T507X2A

Poisoning by analeptics and opioid receptor antagonists, intentional self-harm,
initial encounter

T507X2D

Poisoning by analeptics and opioid receptor antagonists, intentional self-harm,
subsequent encounter

T507X2S

Poisoning by analeptics and opioid receptor antagonists, intentional self-harm,
sequela

T508X2A

Poisoning by diagnostic agents, intentional self-harm, initial encounter

T508X2D

Poisoning by diagnostic agents, intentional self-harm, subsequent encounter

T508X2S

Poisoning by diagnostic agents, intentional self-harm, sequela

T50902A

Poisoning by unspecified drugs, medicaments and biological substances,
intentional self-harm, initial encounter

T50902D

Poisoning by unspecified drugs, medicaments and biological substances,
intentional self-harm, subsequent encounter

T50902S

Poisoning by unspecified drugs, medicaments and biological substances,
intentional self-harm, sequela

T50992A

Poisoning by other drugs, medicaments and biological substances, intentional
self-harm, initial encounter

T50992D

Poisoning by other drugs, medicaments and biological substances, intentional
self-harm, subsequent encounter

105

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T50992S

Poisoning by other drugs, medicaments and biological substances, intentional
self-harm, sequela

T50A12A

Poisoning by pertussis vaccine, including combinations with a pertussis
component, intentional self-harm, initial encounter

T50A12D

Poisoning by pertussis vaccine, including combinations with a pertussis
component, intentional self-harm, subsequent encounter

T50A12S

Poisoning by pertussis vaccine, including combinations with a pertussis
component, intentional self-harm, sequela

T50A22A

Poisoning by mixed bacterial vaccines without a pertussis component,
intentional self-harm, initial encounter

T50A22D

Poisoning by mixed bacterial vaccines without a pertussis component,
intentional self-harm, subsequent encounter

T50A22S

Poisoning by mixed bacterial vaccines without a pertussis component,
intentional self-harm, sequela

T50A92A

Poisoning by other bacterial vaccines, intentional self-harm, initial encounter

T50A92D

Poisoning by other bacterial vaccines, intentional self-harm, subsequent
encounter

T50A92S

Poisoning by other bacterial vaccines, intentional self-harm, sequela

T50B12A

Poisoning by smallpox vaccines, intentional self-harm, initial encounter

T50B12D

Poisoning by smallpox vaccines, intentional self-harm, subsequent encounter

T50B12S

Poisoning by smallpox vaccines, intentional self-harm, sequela

T50B92A

Poisoning by other viral vaccines, intentional self-harm, initial encounter

T50B92D

Poisoning by other viral vaccines, intentional self-harm, subsequent encounter

T50B92S

Poisoning by other viral vaccines, intentional self-harm, sequela

T50Z12A

Poisoning by immunoglobulin, intentional self-harm, initial encounter

T50Z12D

Poisoning by immunoglobulin, intentional self-harm, subsequent encounter

T50Z12S

Poisoning by immunoglobulin, intentional self-harm, sequela

106

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Overdose

T50Z92A

Poisoning by other vaccines and biological substances, intentional self-harm,
initial encounter

T50Z92D

Poisoning by other vaccines and biological substances, intentional self-harm,
subsequent encounter

T50Z92S

Poisoning by other vaccines and biological substances, intentional self-harm,
sequela

Intentional Toxic Exposure. ICD-10-CM codes for poisoning by toxic exposure, primarily from
nonmedicinal substances, are similar to those for drugs; they are categorized as accidental,
intentional, assault, and undetermined, and are coded in categories T51-T65. The codes related
to intentional poisoning are listed in Table 2 below.
Table 2. Suicide Attempt by Intentional Toxic Exposure Codes
Code
Poisoning by Toxic Effect
T510X2A

Toxic effect of ethanol, intentional self-harm, initial encounter

T510X2D

Toxic effect of ethanol, intentional self-harm, subsequent encounter

T510X2S

Toxic effect of ethanol, intentional self-harm, sequela

T511X2A

Toxic effect of methanol, intentional self-harm, initial encounter

T511X2D

Toxic effect of methanol, intentional self-harm, subsequent encounter

T511X2S

Toxic effect of methanol, intentional self-harm, sequela

T512X2A

Toxic effect of 2-Propanol, intentional self-harm, initial encounter

T512X2D

Toxic effect of 2-Propanol, intentional self-harm, subsequent encounter

T512X2S

Toxic effect of 2-Propanol, intentional self-harm, sequela

T513X2A

Toxic effect of fusel oil, intentional self-harm, initial encounter

T513X2D

Toxic effect of fusel oil, intentional self-harm, subsequent encounter

T513X2S

Toxic effect of fusel oil, intentional self-harm, sequela

T518X2A

Toxic effect of other alcohols, intentional self-harm, initial encounter

T518X2D

Toxic effect of other alcohols, intentional self-harm, subsequent encounter

T518X2S

Toxic effect of other alcohols, intentional self-harm, sequela

107

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T5192XA

Toxic effect of unspecified alcohol, intentional self-harm, initial encounter

T5192XD

Toxic effect of unspecified alcohol, intentional self-harm, subsequent encounter

T5192XS

Toxic effect of unspecified alcohol, intentional self-harm, sequela

T520X2A

Toxic effect of petroleum products, intentional self-harm, initial encounter

T520X2D

Toxic effect of petroleum products, intentional self-harm, subsequent encounter

T520X2S

Toxic effect of petroleum products, intentional self-harm, sequela

T521X2A

Toxic effect of benzene, intentional self-harm, initial encounter

T521X2D

Toxic effect of benzene, intentional self-harm, subsequent encounter

T521X2S

Toxic effect of benzene, intentional self-harm, sequela

T522X2A

Toxic effect of homologues of benzene, intentional self-harm, initial encounter

T522X2D

Toxic effect of homologues of benzene, intentional self-harm, subsequent
encounter

T522X2S

Toxic effect of homologues of benzene, intentional self-harm, sequela

T523X2A

Toxic effect of glycols, intentional self-harm, initial encounter

T523X2D

Toxic effect of glycols, intentional self-harm, subsequent encounter

T523X2S

Toxic effect of glycols, intentional self-harm, sequela

T524X2A

Toxic effect of ketones, intentional self-harm, initial encounter

T524X2D

Toxic effect of ketones, intentional self-harm, subsequent encounter

T524X2S

Toxic effect of ketones, intentional self-harm, sequela

T528X2A

Toxic effect of other organic solvents, intentional self-harm, initial encounter

T528X2D

Toxic effect of other organic solvents, intentional self-harm, subsequent
encounter

T528X2S

Toxic effect of other organic solvents, intentional self-harm, sequela

T5292XA

Toxic effect of unspecified organic solvent, intentional self-harm, initial
encounter

108

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T5292XD

Toxic effect of unspecified organic solvent, intentional self-harm, subsequent
encounter

T5292XS

Toxic effect of unspecified organic solvent, intentional self-harm, sequela

T530X2A

Toxic effect of carbon tetrachloride, intentional self-harm, initial encounter

T530X2D

Toxic effect of carbon tetrachloride, intentional self-harm, subsequent encounter

T530X2S

Toxic effect of carbon tetrachloride, intentional self-harm, sequela

T531X2A

Toxic effect of chloroform, intentional self-harm, initial encounter

T531X2D

Toxic effect of chloroform, intentional self-harm, subsequent encounter

T531X2S

Toxic effect of chloroform, intentional self-harm, sequela

T532X2A

Toxic effect of trichloroethylene, intentional self-harm, initial encounter

T532X2D

Toxic effect of trichloroethylene, intentional self-harm, subsequent encounter

T532X2S

Toxic effect of trichloroethylene, intentional self-harm, sequela

T533X2A

Toxic effect of tetrachloroethylene, intentional self-harm, initial encounter

T533X2D

Toxic effect of tetrachloroethylene, intentional self-harm, subsequent encounter

T533X2S

Toxic effect of tetrachloroethylene, intentional self-harm, sequela

T534X2A

Toxic effect of dichloromethane, intentional self-harm, initial encounter

T534X2D

Toxic effect of dichloromethane, intentional self-harm, subsequent encounter

T534X2S

Toxic effect of dichloromethane, intentional self-harm, sequela

T535X2A

Toxic effect of chlorofluorocarbons, intentional self-harm, initial encounter

T535X2D

Toxic effect of chlorofluorocarbons, intentional self-harm, subsequent encounter

T535X2S

Toxic effect of chlorofluorocarbons, intentional self-harm, sequela

T536X2A

Toxic effect of other halogen derivatives of aliphatic hydrocarbons, intentional
self-harm, initial encounter

T536X2D

Toxic effect of other halogen derivatives of aliphatic hydrocarbons, intentional
self-harm, subsequent encounter

109

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T536X2S

Toxic effect of other halogen derivatives of aliphatic hydrocarbons, intentional
self-harm, sequela

T537X2A

Toxic effect of other halogen derivatives of aromatic hydrocarbons, intentional
self-harm, initial encounter

T537X2D

Toxic effect of other halogen derivatives of aromatic hydrocarbons, intentional
self-harm, subsequent encounter

T537X2S

Toxic effect of other halogen derivatives of aromatic hydrocarbons, intentional
self-harm, sequela

T5392XA

Toxic effect of unspecified halogen derivatives of aliphatic and aromatic
hydrocarbons, intentional self-harm, initial encounter

T5392XD

Toxic effect of unspecified halogen derivatives of aliphatic and aromatic
hydrocarbons, intentional self-harm, subsequent encounter

T5392XS

Toxic effect of unspecified halogen derivatives of aliphatic and aromatic
hydrocarbons, intentional self-harm, sequela

T540X2A

Toxic effect of phenol and phenol homologues, intentional self-harm, initial
encounter

T540X2D

Toxic effect of phenol and phenol homologues, intentional self-harm, subsequent
encounter

T540X2S

Toxic effect of phenol and phenol homologues, intentional self-harm, sequela

T541X2A

Toxic effect of other corrosive organic compounds, intentional self-harm, initial
encounter

T541X2D

Toxic effect of other corrosive organic compounds, intentional self-harm,
subsequent encounter

T541X2S

Toxic effect of other corrosive organic compounds, intentional self-harm,
sequela

T542X2A

Toxic effect of corrosive acids and acid-like substances, intentional self-harm,
initial encounter

T542X2D

Toxic effect of corrosive acids and acid-like substances, intentional self-harm,
subsequent encounter

110

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T542X2S

Toxic effect of corrosive acids and acid-like substances, intentional self-harm,
sequela

T543X2A

Toxic effect of corrosive alkalis and alkali-like substances, intentional self-harm,
initial encounter

T543X2D

Toxic effect of corrosive alkalis and alkali-like substances, intentional self-harm,
subsequent encounter

T543X2S

Toxic effect of corrosive alkalis and alkali-like substances, intentional self-harm,
sequela

T5492XA

Toxic effect of unspecified corrosive substance, intentional self-harm, initial
encounter

T5492XD

Toxic effect of unspecified corrosive substance, intentional self-harm,
subsequent encounter

T5492XS

Toxic effect of unspecified corrosive substance, intentional self-harm, sequela

T550X2A

Toxic effect of soaps, intentional self-harm, initial encounter

T550X2D

Toxic effect of soaps, intentional self-harm, subsequent encounter

T550X2S

Toxic effect of soaps, intentional self-harm, sequela

T551X2A

Toxic effect of detergents, intentional self-harm, initial encounter

T551X2D

Toxic effect of detergents, intentional self-harm, subsequent encounter

T551X2S

Toxic effect of detergents, intentional self-harm, sequela

T560X2A

Toxic effect of lead and its compounds, intentional self-harm, initial encounter

T560X2D

Toxic effect of lead and its compounds, intentional self-harm, subsequent
encounter

T560X2S

Toxic effect of lead and its compounds, intentional self-harm, sequela

T561X2A

Toxic effect of mercury and its compounds, intentional self-harm, initial
encounter

T561X2D

Toxic effect of mercury and its compounds, intentional self-harm, subsequent
encounter

T561X2S

Toxic effect of mercury and its compounds, intentional self-harm, sequela

111

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T562X2A

Toxic effect of chromium and its compounds, intentional self-harm, initial
encounter

T562X2D

Toxic effect of chromium and its compounds, intentional self-harm, subsequent
encounter

T562X2S

Toxic effect of chromium and its compounds, intentional self-harm, sequela

T563X2A

Toxic effect of cadmium and its compounds, intentional self-harm, initial
encounter

T563X2D

Toxic effect of cadmium and its compounds, intentional self-harm, subsequent
encounter

T563X2S

Toxic effect of cadmium and its compounds, intentional self-harm, sequela

T564X2A

Toxic effect of copper and its compounds, intentional self-harm, initial encounter

T564X2D

Toxic effect of copper and its compounds, intentional self-harm, subsequent
encounter

T564X2S

Toxic effect of copper and its compounds, intentional self-harm, sequela

T565X2A

Toxic effect of zinc and its compounds, intentional self-harm, initial encounter

T565X2D

Toxic effect of zinc and its compounds, intentional self-harm, subsequent
encounter

T565X2S

Toxic effect of zinc and its compounds, intentional self-harm, sequela

T566X2A

Toxic effect of tin and its compounds, intentional self-harm, initial encounter

T566X2D

Toxic effect of tin and its compounds, intentional self-harm, subsequent
encounter

T566X2S

Toxic effect of tin and its compounds, intentional self-harm, sequela

T567X2A

Toxic effect of beryllium and its compounds, intentional self-harm, initial
encounter

T567X2D

Toxic effect of beryllium and its compounds, intentional self-harm, subsequent
encounter

T567X2S

Toxic effect of beryllium and its compounds, intentional self-harm, sequela

T56812A

Toxic effect of thallium, intentional self-harm, initial encounter

112

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T56812D

Toxic effect of thallium, intentional self-harm, subsequent encounter

T56812S

Toxic effect of thallium, intentional self-harm, sequela

T56892A

Toxic effect of other metals, intentional self-harm, initial encounter

T56892D

Toxic effect of other metals, intentional self-harm, subsequent encounter

T56892S

Toxic effect of other metals, intentional self-harm, sequela

T5692XA

Toxic effect of unspecified metal, intentional self-harm, initial encounter

T5692XD

Toxic effect of unspecified metal, intentional self-harm, subsequent encounter

T5692XS

Toxic effect of unspecified metal, intentional self-harm, sequela

T570X2A

Toxic effect of arsenic and its compounds, intentional self-harm, initial
encounter

T570X2D

Toxic effect of arsenic and its compounds, intentional self-harm, subsequent
encounter

T570X2S

Toxic effect of arsenic and its compounds, intentional self-harm, sequela

T571X2A

Toxic effect of phosphorus and its compounds, intentional self-harm, initial
encounter

T571X2D

Toxic effect of phosphorus and its compounds, intentional self-harm, subsequent
encounter

T571X2S

Toxic effect of phosphorus and its compounds, intentional self-harm, sequela

T572X2A

Toxic effect of manganese and its compounds, intentional self-harm, initial
encounter

T572X2D

Toxic effect of manganese and its compounds, intentional self-harm, subsequent
encounter

T572X2S

Toxic effect of manganese and its compounds, intentional self-harm, sequela

T573X2A

Toxic effect of hydrogen cyanide, intentional self-harm, initial encounter

T573X2D

Toxic effect of hydrogen cyanide, intentional self-harm, subsequent encounter

T573X2S

Toxic effect of hydrogen cyanide, intentional self-harm, sequela

T578X2A

Toxic effect of other specified inorganic substances, intentional self-harm, initial
encounter
113

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T578X2D

Toxic effect of other specified inorganic substances, intentional self-harm,
subsequent encounter

T578X2S

Toxic effect of other specified inorganic substances, intentional self-harm,
sequela

T5792XA

Toxic effect of unspecified inorganic substance, intentional self-harm, initial
encounter

T5792XD

Toxic effect of unspecified inorganic substance, intentional self-harm,
subsequent encounter

T5792XS

Toxic effect of unspecified inorganic substance, intentional self-harm, sequela

T5802XA

Toxic effect of carbon monoxide from motor vehicle exhaust, intentional selfharm, initial encounter

T5802XD

Toxic effect of carbon monoxide from motor vehicle exhaust, intentional selfharm, subsequent encounter

T5802XS

Toxic effect of carbon monoxide from motor vehicle exhaust, intentional selfharm, sequela

T5812XA

Toxic effect of carbon monoxide from utility gas, intentional self-harm, initial
encounter

T5812XD

Toxic effect of carbon monoxide from utility gas, intentional self-harm,
subsequent encounter

T5812XS

Toxic effect of carbon monoxide from utility gas, intentional self-harm, sequela

T582X2A

Toxic effect of carbon monoxide from incomplete combustion of other domestic
fuels, intentional self-harm, initial encounter

T582X2D

Toxic effect of carbon monoxide from incomplete combustion of other domestic
fuels, intentional self-harm, subsequent encounter

T582X2S

Toxic effect of carbon monoxide from incomplete combustion of other domestic
fuels, intentional self-harm, sequela

T588X2A

Toxic effect of carbon monoxide from other source, intentional self-harm, initial
encounter

T588X2D

Toxic effect of carbon monoxide from other source, intentional self-harm,
subsequent encounter

114

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T588X2S

Toxic effect of carbon monoxide from other source, intentional self-harm,
sequela

T5892XA

Toxic effect of carbon monoxide from unspecified source, intentional self-harm,
initial encounter

T5892XD

Toxic effect of carbon monoxide from unspecified source, intentional self-harm,
subsequent encounter

T5892XS

Toxic effect of carbon monoxide from unspecified source, intentional self-harm,
sequela

T590X2A

Toxic effect of nitrogen oxides, intentional self-harm, initial encounter

T590X2D

Toxic effect of nitrogen oxides, intentional self-harm, subsequent encounter

T590X2S

Toxic effect of nitrogen oxides, intentional self-harm, sequela

T591X2A

Toxic effect of sulfur dioxide, intentional self-harm, initial encounter

T591X2D

Toxic effect of sulfur dioxide, intentional self-harm, subsequent encounter

T591X2S

Toxic effect of sulfur dioxide, intentional self-harm, sequela

T592X2A

Toxic effect of formaldehyde, intentional self-harm, initial encounter

T592X2D

Toxic effect of formaldehyde, intentional self-harm, subsequent encounter

T592X2S

Toxic effect of formaldehyde, intentional self-harm, sequela

T593X2A

Toxic effect of lacrimogenic gas, intentional self-harm, initial encounter

T593X2D

Toxic effect of lacrimogenic gas, intentional self-harm, subsequent encounter

T593X2S

Toxic effect of lacrimogenic gas, intentional self-harm, sequela

T594X2A

Toxic effect of chlorine gas, intentional self-harm, initial encounter

T594X2D

Toxic effect of chlorine gas, intentional self-harm, subsequent encounter

T594X2S

Toxic effect of chlorine gas, intentional self-harm, sequela

T595X2A

Toxic effect of fluorine gas and hydrogen fluoride, intentional self-harm, initial
encounter

T595X2D

Toxic effect of fluorine gas and hydrogen fluoride, intentional self-harm,
subsequent encounter

115

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T595X2S

Toxic effect of fluorine gas and hydrogen fluoride, intentional self-harm, sequela

T596X2A

Toxic effect of hydrogen sulfide, intentional self-harm, initial encounter

T596X2D

Toxic effect of hydrogen sulfide, intentional self-harm, subsequent encounter

T596X2S

Toxic effect of hydrogen sulfide, intentional self-harm, sequela

T597X2A

Toxic effect of carbon dioxide, intentional self-harm, initial encounter

T597X2D

Toxic effect of carbon dioxide, intentional self-harm, subsequent encounter

T597X2S

Toxic effect of carbon dioxide, intentional self-harm, sequela

T59812A

Toxic effect of smoke, intentional self-harm, initial encounter

T59812D

Toxic effect of smoke, intentional self-harm, subsequent encounter

T59812S

Toxic effect of smoke, intentional self-harm, sequela

T59892A

Toxic effect of other specified gases, fumes and vapors, intentional self-harm,
initial encounter

T59892D

Toxic effect of other specified gases, fumes and vapors, intentional self-harm,
subsequent encounter

T59892S

Toxic effect of other specified gases, fumes and vapors, intentional self-harm,
sequela

T5992XA

Toxic effect of unspecified gases, fumes and vapors, intentional self-harm, initial
encounter

T5992XD

Toxic effect of unspecified gases, fumes and vapors, intentional self-harm,
subsequent encounter

T5992XS

Toxic effect of unspecified gases, fumes and vapors, intentional self-harm,
sequela

T600X2A

Toxic effect of organophosphate and carbamate insecticides, intentional selfharm, initial encounter

T600X2D

Toxic effect of organophosphate and carbamate insecticides, intentional selfharm, subsequent encounter

T600X2S

Toxic effect of organophosphate and carbamate insecticides, intentional selfharm, sequela

116

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T601X2A

Toxic effect of halogenated insecticides, intentional self-harm, initial encounter

T601X2D

Toxic effect of halogenated insecticides, intentional self-harm, subsequent
encounter

T601X2S

Toxic effect of halogenated insecticides, intentional self-harm, sequela

T601X3A

Toxic effect of halogenated insecticides, assault, initial encounter

T602X2A

Toxic effect of other insecticides, intentional self-harm, initial encounter

T602X2D

Toxic effect of other insecticides, intentional self-harm, subsequent encounter

T602X2S

Toxic effect of other insecticides, intentional self-harm, sequela

T603X2A

Toxic effect of herbicides and fungicides, intentional self-harm, initial encounter

T603X2D

Toxic effect of herbicides and fungicides, intentional self-harm, subsequent
encounter

T603X2S

Toxic effect of herbicides and fungicides, intentional self-harm, sequela

T604X2A

Toxic effect of rodenticides, intentional self-harm, initial encounter

T604X2D

Toxic effect of rodenticides, intentional self-harm, subsequent encounter

T604X2S

Toxic effect of rodenticides, intentional self-harm, sequela

T608X2A

Toxic effect of other pesticides, intentional self-harm, initial encounter

T608X2D

Toxic effect of other pesticides, intentional self-harm, subsequent encounter

T608X2S

Toxic effect of other pesticides, intentional self-harm, sequela

T6092XA

Toxic effect of unspecified pesticide, intentional self-harm, initial encounter

T6092XD

Toxic effect of unspecified pesticide, intentional self-harm, subsequent
encounter

T6092XS

Toxic effect of unspecified pesticide, intentional self-harm, sequela

T6102XA

Ciguatera fish poisoning, intentional self-harm, initial encounter

T6102XD

Ciguatera fish poisoning, intentional self-harm, subsequent encounter

T6102XS

Ciguatera fish poisoning, intentional self-harm, sequela

T6112XA

Scombroid fish poisoning, intentional self-harm, initial encounter

117

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T6112XD

Scombroid fish poisoning, intentional self-harm, subsequent encounter

T6112XS

Scombroid fish poisoning, intentional self-harm, sequela

T61772A

Other fish poisoning, intentional self-harm, initial encounter

T61772D

Other fish poisoning, intentional self-harm, subsequent encounter

T61772S

Other fish poisoning, intentional self-harm, sequela

T61782A

Other shellfish poisoning, intentional self-harm, initial encounter

T61782D

Other shellfish poisoning, intentional self-harm, subsequent encounter

T61782S

Other shellfish poisoning, intentional self-harm, sequela

T618X2A

Toxic effect of other seafood, intentional self-harm, initial encounter

T618X2D

Toxic effect of other seafood, intentional self-harm, subsequent encounter

T618X2S

Toxic effect of other seafood, intentional self-harm, sequela

T6192XA

Toxic effect of unspecified seafood, intentional self-harm, initial encounter

T6192XD

Toxic effect of unspecified seafood, intentional self-harm, subsequent encounter

T6192XS

Toxic effect of unspecified seafood, intentional self-harm, sequela

T620X2A

Toxic effect of ingested mushrooms, intentional self-harm, initial encounter

T620X2D

Toxic effect of ingested mushrooms, intentional self-harm, subsequent encounter

T620X2S

Toxic effect of ingested mushrooms, intentional self-harm, sequela

T621X2A

Toxic effect of ingested berries, intentional self-harm, initial encounter

T621X2D

Toxic effect of ingested berries, intentional self-harm, subsequent encounter

T621X2S

Toxic effect of ingested berries, intentional self-harm, sequela

T622X2A

Toxic effect of other ingested (parts of) plant(s), intentional self-harm, initial
encounter

T622X2D

Toxic effect of other ingested (parts of) plant(s), intentional self-harm,
subsequent encounter

T622X2S

Toxic effect of other ingested (parts of) plant(s), intentional self-harm, sequela

118

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T628X2A

Toxic effect of other specified noxious substances eaten as food, intentional selfharm, initial encounter

T628X2D

Toxic effect of other specified noxious substances eaten as food, intentional selfharm, subsequent encounter

T628X2S

Toxic effect of other specified noxious substances eaten as food, intentional selfharm, sequela

T6292XA

Toxic effect of unspecified noxious substance eaten as food, intentional selfharm, initial encounter

T6292XD

Toxic effect of unspecified noxious substance eaten as food, intentional selfharm, subsequent encounter

T6292XS

Toxic effect of unspecified noxious substance eaten as food, intentional selfharm, sequela

T63002A

Toxic effect of unspecified snake venom, intentional self-harm, initial encounter

T63002D

Toxic effect of unspecified snake venom, intentional self-harm, subsequent
encounter

T63002S

Toxic effect of unspecified snake venom, intentional self-harm, sequela

T63012A

Toxic effect of rattlesnake venom, intentional self-harm, initial encounter

T63012D

Toxic effect of rattlesnake venom, intentional self-harm, subsequent encounter

T63012S

Toxic effect of rattlesnake venom, intentional self-harm, sequela

T63022A

Toxic effect of coral snake venom, intentional self-harm, initial encounter

T63022D

Toxic effect of coral snake venom, intentional self-harm, subsequent encounter

T63022S

Toxic effect of coral snake venom, intentional self-harm, sequela

T63032A

Toxic effect of taipan venom, intentional self-harm, initial encounter

T63032D

Toxic effect of taipan venom, intentional self-harm, subsequent encounter

T63032S

Toxic effect of taipan venom, intentional self-harm, sequela

T63042A

Toxic effect of cobra venom, intentional self-harm, initial encounter

T63042D

Toxic effect of cobra venom, intentional self-harm, subsequent encounter

T63042S

Toxic effect of cobra venom, intentional self-harm, sequela
119

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T63062A

Toxic effect of venom of other North and South American snake, intentional
self-harm, initial encounter

T63062D

Toxic effect of venom of other North and South American snake, intentional
self-harm, subsequent encounter

T63062S

Toxic effect of venom of other North and South American snake, intentional
self-harm, sequela

T63072A

Toxic effect of venom of other Australian snake, intentional self-harm, initial
encounter

T63072D

Toxic effect of venom of other Australian snake, intentional self-harm,
subsequent encounter

T63072S

Toxic effect of venom of other Australian snake, intentional self-harm, sequela

T63082A

Toxic effect of venom of other African and Asian snake, intentional self-harm,
initial encounter

T63082D

Toxic effect of venom of other African and Asian snake, intentional self-harm,
subsequent encounter

T63082S

Toxic effect of venom of other African and Asian snake, intentional self-harm,
sequela

T63092A

Toxic effect of venom of other snake, intentional self-harm, initial encounter

T63092D

Toxic effect of venom of other snake, intentional self-harm, subsequent
encounter

T63092S

Toxic effect of venom of other snake, intentional self-harm, sequela

T63112A

Toxic effect of venom of gila monster, intentional self-harm, initial encounter

T63112D

Toxic effect of venom of gila monster, intentional self-harm, subsequent
encounter

T63112S

Toxic effect of venom of gila monster, intentional self-harm, sequela

T63122A

Toxic effect of venom of other venomous lizard, intentional self-harm, initial
encounter

T63122D

Toxic effect of venom of other venomous lizard, intentional self-harm,
subsequent encounter

120

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T63122S

Toxic effect of venom of other venomous lizard, intentional self-harm, sequela

T63192A

Toxic effect of venom of other reptiles, intentional self-harm, initial encounter

T63192D

Toxic effect of venom of other reptiles, intentional self-harm, subsequent
encounter

T63192S

Toxic effect of venom of other reptiles, intentional self-harm, sequela

T632X2A

Toxic effect of venom of scorpion, intentional self-harm, initial encounter

T632X2D

Toxic effect of venom of scorpion, intentional self-harm, subsequent encounter

T632X2S

Toxic effect of venom of scorpion, intentional self-harm, sequela

T63302A

Toxic effect of unspecified spider venom, intentional self-harm, initial encounter

T63302D

Toxic effect of unspecified spider venom, intentional self-harm, subsequent
encounter

T63302S

Toxic effect of unspecified spider venom, intentional self-harm, sequela

T63312A

Toxic effect of venom of black widow spider, intentional self-harm, initial
encounter

T63312D

Toxic effect of venom of black widow spider, intentional self-harm, subsequent
encounter

T63312S

Toxic effect of venom of black widow spider, intentional self-harm, sequela

T63322A

Toxic effect of venom of tarantula, intentional self-harm, initial encounter

T63322D

Toxic effect of venom of tarantula, intentional self-harm, subsequent encounter

T63322S

Toxic effect of venom of tarantula, intentional self-harm, sequela

T63332A

Toxic effect of venom of brown recluse spider, intentional self-harm, initial
encounter

T63332D

Toxic effect of venom of brown recluse spider, intentional self-harm, subsequent
encounter

T63332S

Toxic effect of venom of brown recluse spider, intentional self-harm, sequela

T63392A

Toxic effect of venom of other spider, intentional self-harm, initial encounter

T63392D

Toxic effect of venom of other spider, intentional self-harm, subsequent
encounter
121

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T63392S

Toxic effect of venom of other spider, intentional self-harm, sequela

T63412A

Toxic effect of venom of centipedes and venomous millipedes, intentional selfharm, initial encounter

T63412D

Toxic effect of venom of centipedes and venomous millipedes, intentional selfharm, subsequent encounter

T63412S

Toxic effect of venom of centipedes and venomous millipedes, intentional selfharm, sequela

T63422A

Toxic effect of venom of ants, intentional self-harm, initial encounter

T63422D

Toxic effect of venom of ants, intentional self-harm, subsequent encounter

T63422S

Toxic effect of venom of ants, intentional self-harm, sequela

T63432A

Toxic effect of venom of caterpillars, intentional self-harm, initial encounter

T63432D

Toxic effect of venom of caterpillars, intentional self-harm, subsequent
encounter

T63432S

Toxic effect of venom of caterpillars, intentional self-harm, sequela

T63442A

Toxic effect of venom of bees, intentional self-harm, initial encounter

T63442D

Toxic effect of venom of bees, intentional self-harm, subsequent encounter

T63442S

Toxic effect of venom of bees, intentional self-harm, sequela

T63452A

Toxic effect of venom of hornets, intentional self-harm, initial encounter

T63452D

Toxic effect of venom of hornets, intentional self-harm, subsequent encounter

T63452S

Toxic effect of venom of hornets, intentional self-harm, sequela

T63462A

Toxic effect of venom of wasps, intentional self-harm, initial encounter

T63462D

Toxic effect of venom of wasps, intentional self-harm, subsequent encounter

T63462S

Toxic effect of venom of wasps, intentional self-harm, sequela

T63482A

Toxic effect of venom of other arthropod, intentional self-harm, initial encounter

T63482D

Toxic effect of venom of other arthropod, intentional self-harm, subsequent
encounter

T63482S

Toxic effect of venom of other arthropod, intentional self-harm, sequela

122

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T63512A

Toxic effect of contact with stingray, intentional self-harm, initial encounter

T63512D

Toxic effect of contact with stingray, intentional self-harm, subsequent
encounter

T63512S

Toxic effect of contact with stingray, intentional self-harm, sequela

T63592A

Toxic effect of contact with other venomous fish, intentional self-harm, initial
encounter

T63592D

Toxic effect of contact with other venomous fish, intentional self-harm,
subsequent encounter

T63592S

Toxic effect of contact with other venomous fish, intentional self-harm, sequela

T63612A

Toxic effect of contact with Portugese Man-o-war, intentional self-harm, initial
encounter

T63612D

Toxic effect of contact with Portugese Man-o-war, intentional self-harm,
subsequent encounter

T63612S

Toxic effect of contact with Portugese Man-o-war, intentional self-harm, sequela

T63622A

Toxic effect of contact with other jellyfish, intentional self-harm, initial
encounter

T63622D

Toxic effect of contact with other jellyfish, intentional self-harm, subsequent
encounter

T63622S

Toxic effect of contact with other jellyfish, intentional self-harm, sequela

T63632A

Toxic effect of contact with sea anemone, intentional self-harm, initial encounter

T63632D

Toxic effect of contact with sea anemone, intentional self-harm, subsequent
encounter

T63632S

Toxic effect of contact with sea anemone, intentional self-harm, sequela

T63692A

Toxic effect of contact with other venomous marine animals, intentional selfharm, initial encounter

T63692D

Toxic effect of contact with other venomous marine animals, intentional selfharm, subsequent encounter

T63692S

Toxic effect of contact with other venomous marine animals, intentional selfharm, sequela

123

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T63712A

Toxic effect of contact with venomous marine plant, intentional self-harm, initial
encounter

T63712D

Toxic effect of contact with venomous marine plant, intentional self-harm,
subsequent encounter

T63712S

Toxic effect of contact with venomous marine plant, intentional self-harm,
sequela

T63792A

Toxic effect of contact with other venomous plant, intentional self-harm, initial
encounter

T63792D

Toxic effect of contact with other venomous plant, intentional self-harm,
subsequent encounter

T63792S

Toxic effect of contact with other venomous plant, intentional self-harm, sequela

T63812A

Toxic effect of contact with venomous frog, intentional self-harm, initial
encounter

T63812D

Toxic effect of contact with venomous frog, intentional self-harm, subsequent
encounter

T63812S

Toxic effect of contact with venomous frog, intentional self-harm, sequela

T63822A

Toxic effect of contact with venomous toad, intentional self-harm, initial
encounter

T63822D

Toxic effect of contact with venomous toad, intentional self-harm, subsequent
encounter

T63822S

Toxic effect of contact with venomous toad, intentional self-harm, sequela

T63832A

Toxic effect of contact with other venomous amphibian, intentional self-harm,
initial encounter

T63832D

Toxic effect of contact with other venomous amphibian, intentional self-harm,
subsequent encounter

T63832S

Toxic effect of contact with other venomous amphibian, intentional self-harm,
sequela

T63892A

Toxic effect of contact with other venomous animals, intentional self-harm,
initial encounter

124

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T63892D

Toxic effect of contact with other venomous animals, intentional self-harm,
subsequent encounter

T63892S

Toxic effect of contact with other venomous animals, intentional self-harm,
sequela

T6392XA

Toxic effect of contact with unspecified venomous animal, intentional self-harm,
initial encounter

T6392XD

Toxic effect of contact with unspecified venomous animal, intentional self-harm,
subsequent encounter

T6392XS

Toxic effect of contact with unspecified venomous animal, intentional self-harm,
sequela

T6402XA

Toxic effect of aflatoxin, intentional self-harm, initial encounter

T6402XD

Toxic effect of aflatoxin, intentional self-harm, subsequent encounter

T6402XS

Toxic effect of aflatoxin, intentional self-harm, sequela

T6482XA

Toxic effect of other mycotoxin food contaminants, intentional self-harm, initial
encounter

T6482XD

Toxic effect of other mycotoxin food contaminants, intentional self-harm,
subsequent encounter

T6482XS

Toxic effect of other mycotoxin food contaminants, intentional self-harm,
sequela

T650X2A

Toxic effect of cyanides, intentional self-harm, initial encounter

T650X2D

Toxic effect of cyanides, intentional self-harm, subsequent encounter

T650X2S

Toxic effect of cyanides, intentional self-harm, sequela

T651X2A

Toxic effect of strychnine and its salts, intentional self-harm, initial encounter

T651X2D

Toxic effect of strychnine and its salts, intentional self-harm, subsequent
encounter

T651X2S

Toxic effect of strychnine and its salts, intentional self-harm, sequela

T65212A

Toxic effect of chewing tobacco, intentional self-harm, initial encounter

T65212D

Toxic effect of chewing tobacco, intentional self-harm, subsequent encounter

125

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T65212S

Toxic effect of chewing tobacco, intentional self-harm, sequela

T65222A

Toxic effect of tobacco cigarettes, intentional self-harm, initial encounter

T65222D

Toxic effect of tobacco cigarettes, intentional self-harm, subsequent encounter

T65222S

Toxic effect of tobacco cigarettes, intentional self-harm, sequela

T65292A

Toxic effect of other tobacco and nicotine, intentional self-harm, initial
encounter

T65292D

Toxic effect of other tobacco and nicotine, intentional self-harm, subsequent
encounter

T65292S

Toxic effect of other tobacco and nicotine, intentional self-harm, sequela

T653X2A

Toxic effect of nitroderivatives and aminoderivatives of benzene and its
homologues, intentional self-harm, initial encounter

T653X2D

Toxic effect of nitroderivatives and aminoderivatives of benzene and its
homologues, intentional self-harm, subsequent encounter

T653X2S

Toxic effect of nitroderivatives and aminoderivatives of benzene and its
homologues, intentional self-harm, sequela

T654X2A

Toxic effect of carbon disulfide, intentional self-harm, initial encounter

T654X2D

Toxic effect of carbon disulfide, intentional self-harm, subsequent encounter

T654X2S

Toxic effect of carbon disulfide, intentional self-harm, sequela

T655X2A

Toxic effect of nitroglycerin and other nitric acids and esters, intentional selfharm, initial encounter

T655X2D

Toxic effect of nitroglycerin and other nitric acids and esters, intentional selfharm, subsequent encounter

T655X2S

Toxic effect of nitroglycerin and other nitric acids and esters, intentional selfharm, sequela

T656X2A

Toxic effect of paints and dyes, not elsewhere classified, intentional self-harm,
initial encounter

T656X2D

Toxic effect of paints and dyes, not elsewhere classified, intentional self-harm,
subsequent encounter

126

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Poisoning by Toxic Effect

T656X2S

Toxic effect of paints and dyes, not elsewhere classified, intentional self-harm,
sequela

T65812A

Toxic effect of latex, intentional self-harm, initial encounter

T65812D

Toxic effect of latex, intentional self-harm, subsequent encounter

T65812S

Toxic effect of latex, intentional self-harm, sequela

T65822A

Toxic effect of harmful algae and algae toxins, intentional self-harm, initial
encounter

T65822D

Toxic effect of harmful algae and algae toxins, intentional self-harm, subsequent
encounter

T65822S

Toxic effect of harmful algae and algae toxins, intentional self-harm, sequela

T65832A

Toxic effect of fiberglass, intentional self-harm, initial encounter

T65832D

Toxic effect of fiberglass, intentional self-harm, subsequent encounter

T65832S

Toxic effect of fiberglass, intentional self-harm, sequela

T65892A

Toxic effect of other specified substances, intentional self-harm, initial encounter

T65892D

Toxic effect of other specified substances, intentional self-harm, subsequent
encounter

T65892S

Toxic effect of other specified substances, intentional self-harm, sequela

T6592XA

Toxic effect of unspecified substance, intentional self-harm, initial encounter

T6592XD

Toxic effect of unspecified substance, intentional self-harm, subsequent
encounter

T6592XS

Toxic effect of unspecified substance, intentional self-harm, sequela

Intentional Self-Inflicted Injury. ICD-10-CM codes related to self-inflicted injuries that do not
involve poisoning are coded to the specific injury followed by an external cause of injury code
(if reported) (codes X71-X83). Those codes are listed in Table 3 below.
Table 3. Suicide Attempt by Self-Inflicted Injury Codes
Code
Self-Inflicted Injury
X710XXA

Intentional self-harm by drowning and submersion while in bathtub, initial
encounter
127

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Self-Inflicted Injury

X710XXD

Intentional self-harm by drowning and submersion while in bathtub, subsequent
encounter

X710XXS

Intentional self-harm by drowning and submersion while in bathtub, sequela

X711XXA

Intentional self-harm by drowning and submersion while in swimming pool,
initial encounter

X711XXD

Intentional self-harm by drowning and submersion while in swimming pool,
subsequent encounter

X711XXS

Intentional self-harm by drowning and submersion while in swimming pool,
sequela

X712XXA

Intentional self-harm by drowning and submersion after jump into swimming
pool, initial encounter

X712XXD

Intentional self-harm by drowning and submersion after jump into swimming
pool, subsequent encounter

X712XXS

Intentional self-harm by drowning and submersion after jump into swimming
pool, sequela

X713XXA

Intentional self-harm by drowning and submersion in natural water, initial
encounter

X713XXD

Intentional self-harm by drowning and submersion in natural water, subsequent
encounter

X713XXS

Intentional self-harm by drowning and submersion in natural water, sequela

X718XXA

Other intentional self-harm by drowning and submersion, initial encounter

X718XXD

Other intentional self-harm by drowning and submersion, subsequent encounter

X718XXS

Other intentional self-harm by drowning and submersion, sequela

X719XXA

Intentional self-harm by drowning and submersion, unspecified, initial encounter

X719XXD

Intentional self-harm by drowning and submersion, unspecified, subsequent
encounter

X719XXS

Intentional self-harm by drowning and submersion, unspecified, sequela

X72XXXA Intentional self-harm by handgun discharge, initial encounter
X72XXXD Intentional self-harm by handgun discharge, subsequent encounter
128

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Self-Inflicted Injury

X72XXXS

Intentional self-harm by handgun discharge, sequela

X730XXA

Intentional self-harm by shotgun discharge, initial encounter

X730XXD

Intentional self-harm by shotgun discharge, subsequent encounter

X730XXS

Intentional self-harm by shotgun discharge, sequela

X731XXA

Intentional self-harm by hunting rifle discharge, initial encounter

X731XXD

Intentional self-harm by hunting rifle discharge, subsequent encounter

X731XXS

Intentional self-harm by hunting rifle discharge, sequela

X732XXA

Intentional self-harm by machine gun discharge, initial encounter

X732XXD

Intentional self-harm by machine gun discharge, subsequent encounter

X732XXS

Intentional self-harm by machine gun discharge, sequela

X738XXA

Intentional self-harm by other larger firearm discharge, initial encounter

X738XXD

Intentional self-harm by other larger firearm discharge, subsequent encounter

X738XXS

Intentional self-harm by other larger firearm discharge, sequela

X739XXA

Intentional self-harm by unspecified larger firearm discharge, initial encounter

X739XXD

Intentional self-harm by unspecified larger firearm discharge, subsequent
encounter

X739XXS

Intentional self-harm by unspecified larger firearm discharge, sequela

X7401XA

Intentional self-harm by airgun, initial encounter

X7401XD

Intentional self-harm by airgun, subsequent encounter

X7401XS

Intentional self-harm by airgun, sequela

X7402XA

Intentional self-harm by paintball gun, initial encounter

X7402XD

Intentional self-harm by paintball gun, subsequent encounter

X7402XS

Intentional self-harm by paintball gun, sequela

X7409XA

Intentional self-harm by other gas, air or spring-operated gun, initial encounter

X7409XD

Intentional self-harm by other gas, air or spring-operated gun, subsequent
encounter
129

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Self-Inflicted Injury

X7409XS

Intentional self-harm by other gas, air or spring-operated gun, sequela

X748XXA

Intentional self-harm by other firearm discharge, initial encounter

X748XXD

Intentional self-harm by other firearm discharge, subsequent encounter

X748XXS

Intentional self-harm by other firearm discharge, sequela

X749XXA

Intentional self-harm by unspecified firearm discharge, initial encounter

X749XXD

Intentional self-harm by unspecified firearm discharge, subsequent encounter

X749XXS

Intentional self-harm by unspecified firearm discharge, sequela

X75XXXA Intentional self-harm by explosive material, initial encounter
X75XXXD Intentional self-harm by explosive material, subsequent encounter
X75XXXS

Intentional self-harm by explosive material, sequela

X76XXXA Intentional self-harm by smoke, fire and flames, initial encounter
X76XXXD Intentional self-harm by smoke, fire and flames, subsequent encounter
X76XXXS

Intentional self-harm by smoke, fire and flames, sequela

X770XXA

Intentional self-harm by steam or hot vapors, initial encounter

X770XXD

Intentional self-harm by steam or hot vapors, subsequent encounter

X770XXS

Intentional self-harm by steam or hot vapors, sequela

X771XXA

Intentional self-harm by hot tap water, initial encounter

X771XXD

Intentional self-harm by hot tap water, subsequent encounter

X771XXS

Intentional self-harm by hot tap water, sequela

X772XXA

Intentional self-harm by other hot fluids, initial encounter

X772XXD

Intentional self-harm by other hot fluids, subsequent encounter

X772XXS

Intentional self-harm by other hot fluids, sequela

X773XXA

Intentional self-harm by hot household appliances, initial encounter

X773XXD

Intentional self-harm by hot household appliances, subsequent encounter

X773XXS

Intentional self-harm by hot household appliances, sequela

130

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Self-Inflicted Injury

X778XXA

Intentional self-harm by other hot objects, initial encounter

X778XXD

Intentional self-harm by other hot objects, subsequent encounter

X778XXS

Intentional self-harm by other hot objects, sequela

X779XXA

Intentional self-harm by unspecified hot objects, initial encounter

X779XXD

Intentional self-harm by unspecified hot objects, subsequent encounter

X779XXS

Intentional self-harm by unspecified hot objects, sequela

X780XXA

Intentional self-harm by sharp glass, initial encounter

X780XXD

Intentional self-harm by sharp glass, subsequent encounter

X780XXS

Intentional self-harm by sharp glass, sequela

X781XXA

Intentional self-harm by knife, initial encounter

X781XXD

Intentional self-harm by knife, subsequent encounter

X781XXS

Intentional self-harm by knife, sequela

X782XXA

Intentional self-harm by sword or dagger, initial encounter

X782XXD

Intentional self-harm by sword or dagger, subsequent encounter

X782XXS

Intentional self-harm by sword or dagger, sequela

X788XXA

Intentional self-harm by other sharp object, initial encounter

X788XXD

Intentional self-harm by other sharp object, subsequent encounter

X788XXS

Intentional self-harm by other sharp object, sequela

X789XXA

Intentional self-harm by unspecified sharp object, initial encounter

X789XXD

Intentional self-harm by unspecified sharp object, subsequent encounter

X789XXS

Intentional self-harm by unspecified sharp object, sequela

X79XXXA Intentional self-harm by blunt object, initial encounter
X79XXXD Intentional self-harm by blunt object, subsequent encounter
X79XXXS

Intentional self-harm by blunt object, sequela

X80XXXA Intentional self-harm by jumping from a high place, initial encounter

131

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Self-Inflicted Injury

X80XXXD Intentional self-harm by jumping from a high place, subsequent encounter
X80XXXS

Intentional self-harm by jumping from a high place, sequela

X810XXA

Intentional self-harm by jumping or lying in front of motor vehicle, initial
encounter

X810XXD

Intentional self-harm by jumping or lying in front of motor vehicle, subsequent
encounter

X810XXS

Intentional self-harm by jumping or lying in front of motor vehicle, sequela

X811XXA

Intentional self-harm by jumping or lying in front of (subway) train, initial
encounter

X811XXD

Intentional self-harm by jumping or lying in front of (subway) train, subsequent
encounter

X811XXS

Intentional self-harm by jumping or lying in front of (subway) train, sequela

X818XXA

Intentional self-harm by jumping or lying in front of other moving object, initial
encounter

X818XXD

Intentional self-harm by jumping or lying in front of other moving object,
subsequent encounter

X818XXS

Intentional self-harm by jumping or lying in front of other moving object,
sequela

X820XXA

Intentional collision of motor vehicle with other motor vehicle, initial encounter

X820XXD

Intentional collision of motor vehicle with other motor vehicle, subsequent
encounter

X820XXS

Intentional collision of motor vehicle with other motor vehicle, sequela

X821XXA

Intentional collision of motor vehicle with train, initial encounter

X821XXD

Intentional collision of motor vehicle with train, subsequent encounter

X821XXS

Intentional collision of motor vehicle with train, sequela

X822XXA

Intentional collision of motor vehicle with tree, initial encounter

X822XXD

Intentional collision of motor vehicle with tree, subsequent encounter

X822XXS

Intentional collision of motor vehicle with tree, sequela

132

Appendix SU-A. ICD-10-CM Codes Relevant to Calculating Suicide Attempts

Code

Self-Inflicted Injury

X828XXA

Other intentional self-harm by crashing of motor vehicle, initial encounter

X828XXD

Other intentional self-harm by crashing of motor vehicle, subsequent encounter

X828XXS

Other intentional self-harm by crashing of motor vehicle, sequela

X830XXA

Intentional self-harm by crashing of aircraft, initial encounter

X830XXD

Intentional self-harm by crashing of aircraft, subsequent encounter

X830XXS

Intentional self-harm by crashing of aircraft, sequela

X831XXA

Intentional self-harm by electrocution, initial encounter

X831XXD

Intentional self-harm by electrocution, subsequent encounter

X831XXS

Intentional self-harm by electrocution, sequela

X832XXA

Intentional self-harm by exposure to extremes of cold, initial encounter

X832XXD

Intentional self-harm by exposure to extremes of cold, subsequent encounter

X832XXS

Intentional self-harm by exposure to extremes of cold, sequela

X838XXA

Intentional self-harm by other specified means, initial encounter

X838XXD

Intentional self-harm by other specified means, subsequent encounter

X838XXS

Intentional self-harm by other specified means, sequela

Suicidal Ideation and Suicide Attempt Codes: Suicidal ideation is coded as R45851, but that
code alone is insufficient to warrant inclusion in the numerator. Suicidal ideation accompanied
by a code indicating injury is required for reliance on the ideation code.
The suicide attempt code T1491 is only used if there is no other documentation that identifies a
more detailed code.

133

Appendix PCR-BH: Plan All-Cause Readmissions Rate

Appendix PCR-BH: Plan All-Cause Readmissions Rate
The number of acute inpatient stays for consumers age 18 and older during the measurement year that were followed by an
unplanned acute readmission for any diagnosis within 30 days.
Table PCR-A: Plan All-Cause Readmissions Rates by Age and Risk Adjustment: Ages 18 to 64

Age

Count of Index
Stays
(Denominator)
(1)

Count of 30-Day
Readmissions
(Numerator)
(2)

Observed
Readmissions
(Num/Den)
(3)

Average
Adjusted
Probability
(4)

Total
Variance
(5)

O/E Ratio
(Observed
Readmissions/
Average Adjusted
Probability)
(6)

Lower
Confidence
Interval
(O/E Ratio)

Upper
Confidence
Interval
(O/E Ratio)

18-44
45-54
55-64
Total
Note: This measure requires risk adjustment. However, there are no standardized risk adjustment tables for Medicaid. Therefore, it is suggested
that states report the unadjusted total rates for this measure (columns 1, 2, and 3) because Medicaid-specific risk adjustment tables are required to
calculate columns 4, 5, 6, and the confidence intervals.
Table PCR-B. Plan All-Cause Readmissions Rates by Age and Risk Adjustment: Age 65 and Older

Age

Count of Index
Stays
(Denominator)
(1)

Count of 30-Day
Readmissions
(Numerator) (2)

Observed
Readmissions
(Num/Den) (3)

Average
Adjusted
Probability
(4)

Total
Variance
(5)

O/E Ratio
(Observed
Readmissions/
Average Adjusted
Probability) (6)

Lower
Confidence
Interval
(O/E Ratio)

Upper
Confidence
Interval
(O/E Ratio)

65-74
75-84
85+
134

Appendix PCR-BH: Plan All-Cause Readmissions Rate

Age

Count of Index
Stays
(Denominator)
(1)

Count of 30-Day
Readmissions
(Numerator) (2)

Observed
Readmissions
(Num/Den) (3)

Average
Adjusted
Probability
(4)

Total
Variance
(5)

O/E Ratio
(Observed
Readmissions/
Average Adjusted
Probability) (6)

Lower
Confidence
Interval
(O/E Ratio)

Upper
Confidence
Interval
(O/E Ratio)

Total
Note: This measure requires risk adjustment. However, there are no standardized risk adjustment tables for Medicaid. Therefore, CMS suggests
that states report the unadjusted total rates for this measure (columns 1, 2, and 3) because Medicaid-specific risk adjustment tables are required to
calculate columns 4, 5, and 6.

135

Appendix AMS-BD: Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder

Appendix AMS-BD: Adherence to Mood Stabilizers for Individuals with
Bipolar I Disorder
Table 1. Codes Used to Identify Bipolar I Disorder Diagnosis
Category

Codes

Bipolar I Disorder Diagnosis

F30.10, F30.11, F30.12, F30.13, F30.2, F30.3, F30.4, F30.9,
F31.0, F31.10, F31.11, F31.12, F31.13, F31.2, F31.30,
F31.31, F31.32, F31.4, F31.5, F31.60, F31.61, F31.62,
F31.63, F31.64, F31.70, F31.71, F31.72, F31.73, F31.74,
F31.75, F31.76, F31.77, F31.78,
F31.89, F31.9

Table 2.1. Codes Used to Identify Outpatient Setting Encounter Type
Category

Codes

Current Procedural
Terminology (CPT®)

98960–98962, 99078, 99201–99205, 99211–99215, 99217–
99220, 99241–99245, 99341–99345, 99347–99350, 99385–
99387, 99395–99397, 99401–99404, 99411, 99412, 99429,
99510

Healthcare Common
Procedure Coding System
(HCPCS)

G0155, G0176, G0177, G0409–G0411, G0463, H0002,
H0004, H0031, H0034–H0037, H0039, H0040, H2000,
H2001, H2010–H2020, M0064, S0201, S9480, S9484,
S9485, T1015

Uniform Billing (UB) UB-92
revenue

0510, 0511, 0513, 0516–0517, 0519–0523, 0526–0529,
0770, 0771, 0779, 0900–0905, 0907, 0911–0917, 0919,
0982, 0983

CPT

90791, 90792, 90832–90834, 90836–90840, 90845, 90847,
90849, 90853, 90863, 90867–90870, 90875, 90876, 90880,
99221–99223, 99231–99233, 99238, 99239, 99251–99255,
99291

With Place of Service (POS)

03, 05, 07, 09, 11, 12, 13, 14, 15, 20, 22, 24, 33, 49, 50, 52,
53, 71, 72

136

Appendix AMS-BD: Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder

Table 2.2. Codes Used to Identify ED Setting Encounter Type
Category

Codes

CPT

99281–99285

UB-92 revenue

0450, 0451, 0452, 0456, 0459, 0981

CPT

90791, 90792, 90832–90834, 90836–90840, 90845, 90847,
90849, 90853, 90863, 90867–90870, 90875, 90876, 99291

With Place of Service (POS)

23

Table 2.3. Codes Used to Identify Nonacute Inpatient Setting Encounter Type
Category

Codes

CPT

99304–99310, 99315, 99316, 99318, 99324–99328,
99334–99337

HCPCS

H0017–H0019, T2048

UB-92 revenue

0118, 0128, 0138, 0148, 0158, 0190–0194, 0199, 0524,
0525, 0550–0552, 0559, 0660–0663, 0669, 1000, 1001,
1003–1005

CPT

90791, 90792, 90832–90834, 90836–90840, 90845, 90847,
90849, 90853, 90863, 90867–90870, 90875, 90876, 99291

WITH POS

31, 32, 56

Table 2.4. Codes Used to Identify Acute Inpatient Setting Encounter Type
Category

Codes

UB-92 revenue

0100, 0101, 0110–0114, 0119–0124, 0129–0134, 0139–
0144, 0149–0154, 0159, 0160, 0164, 0167, 0169, 0200–
0204, 0206–0209, 0210–0214, 0219, 0720–0724, 0729,
0987

CPT

90791, 90792, 90832–90834, 90836–90840, 90845, 90847,
90849, 90853, 90863, 90867–90870, 90875, 90876,
99221–99223, 99231–99233, 99238, 99239, 99251–99255,
99291

137

Appendix AMS-BD: Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder

Category

Codes

WITH POS

21, 51

The following are the mood stabilizer medications by class for the denominator. The route of
administration includes all oral formulations of the medications listed below.
Table 3. Mood Stabilizer Medications
Class

Medication

Anticonvulsants

carbamazepine
divalproex sodium
lamotrigine
valproic acid

Atypical Antipsychotics

aripiprazole
asenapine
clozapine
iloperidone
lurasidone
olanzapine
paliperidone
quetiapine
risperidone
ziprasidone

Phenothiazine/Related
Antipsychotics

chlorpromazine
fluphenazine
haloperidol
loxapine succinate
molindone
perphenazine
pimozide
prochlorperazine
thioridazine
thiothixene
trifluoperazine

Other Antipsychotics

olanzapine-fluoxetine

138

Appendix AMS-BD: Adherence to Mood Stabilizers for Individuals with Bipolar I Disorder

Class

Medication

Lithium Salts

lithium carbonate
lithium citrate

Note: Active ingredients listed above are limited to oral, buccal, sublingual, and translingual
formulations only. Obsolete drug products are excluded from National Drug Codes (NDCs) with
an inactive date more than 3 years prior to the beginning of the measurement period or look-back
period, if applicable.

The following are the long-acting (depot) injectable antipsychotic medications by class for the
denominator. The route of administration includes all injectable and intramuscular formulations
of the medications listed below.
Table 4: Long-Acting Injectable Antipsychotic Medications
Class

Medication

Typical Antipsychotic
Medications

fluphenazine decanoate (J2680)
haloperidol decanoate (J1631)

Atypical Antipsychotic
Medications

aripiprazole (J0401)
olanzapine pamoate (J2358)
paliperidone palmitate (J2426)
risperidone microspheres (J2794)

Long-Acting (Depot)
Injectable Antipsychotic
Medications

fluphenazine decanoate (J2680) – 28 days’ supply
haloperidol decanoate (J1631) – 28 days’ supply
aripiprazole (J0401) – 28 days’ supply
olanzapine pamoate (J2358) – 28 days’ supply
paliperidone palmitate (J2426) – 28 days’ supply
risperidone microspheres (J2794) – 14 days’ supply

Note: Since the days’ supply variable is not reliable for long-acting injections in administrative

data, the days’ supply is imputed for the long-acting (depot) injectable antipsychotic medications
listed above.

139

Appendix SAA-BH: Adherence to Antipsychotics for Individuals with Schizophrenia

Appendix SAA-BH: Adherence to Antipsychotics for Individuals with
Schizophrenia
Table SAA-A: Antipsychotic Medications
Description

Prescription

Miscellaneous antipsychotic
agents (oral)

Aripiprazole

Covered Days

Asenapine
Brexpiprazole
Clozapine
Haloperidol
Iloperidone
Loxapine
Lurisadone
Molindone
Olanzapine
Paliperidone
Pimozide
Quetiapine
Quetiapine fumarate
Risperidone
Ziprasidone

Phenothiazine antipsychotics
(oral)

Chloropromazine
Fluphenazine
Perphenazine
Perphenazine-amitriptyline
Prochloroperazine
Thioridazine
Trifluoperazine

Psychotherapeutic
combinations (oral)

Fluoxetine-olanzapine

Thioxanthenes (oral)

Thiothixene

140

Appendix SAA-BH: Adherence to Antipsychotics for Individuals with Schizophrenia

Description

Prescription

Covered Days

Long-acting injections

Aripiprazole

28 days supply

Fluphenazine decanoate
Haloperidol decanoate
Olanzapine.
Paliperidone palmitate
Risperidone

14 days supply

Note: NCQA’s National Drug Code (NDC) current list of antipsychotic medications can
be found at: HEDIS NDC page.

141

Appendix ADD-BH: Follow-Up Care for Children Prescribed Attention-Deficit Hyperactivity Disorder
(ADHD) Medication
Please see NCQA Notice of Copyright and Disclaimers in front matter to Volume 1 of this manual.

Appendix ADD-BH: Follow-Up Care for Children Prescribed AttentionDeficit Hyperactivity Disorder (ADHD) Medication
Table ADD.A. ADHD Medications
Description

Prescription

CNS stimulants

Amphetamine-dextroamphetamine
Dexmethylphenidate
Dextroamphetamine
Lisdexamfetamine
Methamphetamine
Methylphenidate

Alpha-2 receptor agonists

Clonidine
Guanfacine

Miscellaneous ADHD medications

Atomoxetine

Note: NCQA’s National Drug Code (NDC) current list of ADHD medications can be found at:
HEDIS NDC page

142

Appendix AMM-BH: Antidepressant Medication Management
Please see NCQA Notice of Copyright and Disclaimers in front matter to Volume 1 of this manual.

Appendix AMM-BH: Antidepressant Medication Management
Table AMM-C: Antidepressant Medications
Description

Prescription

Miscellaneous antidepressants

Bupropion
Vilazodone
Vortioxetine

Monoamine oxidase inhibitors

Isocarboxazid
Phenelzine
Selegiline
Tranylcypromine

Phyenylpiperazine antidepressants

Nefazodone
Trazodone

Psychotherapeutic combinations

Amitriptyline-chlordiazepoxide
Amitriptyline-perphenazine
Fluoxetine-olanzapine

SSNRI antidepressants

Desvenlafaxine
Duloxetine
Levomilnacipran
Venlafaxine

SSRI antidepressants

Citalopram
Escitalopram
Fluoxetine
Fluvoxamine
Paroxetine
Sertraline

Tetracyclic antidepressants

Maprotiline
Mirtazapine

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Appendix AMM-BH: Antidepressant Medication Management
Please see NCQA Notice of Copyright and Disclaimers in front matter to Volume 1 of this manual.

Description

Prescription

Tricyclic antidepressants

Amitriptyline
Amoxapine
Clomipramine
Desipramine
Doxepin (>6 mg)
Imipramine
Nortriptyline
Protriptyline
Trimipramine

Note: NCQA’s National Drug Code (NDC) current list of antidepressant medications
can be found at: HEDIS NDC page

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