Follow-Up After ED Visit for People With Multiple High-Risk Chronic Conditions (FMC)

What Is the Measure?

The measures looks at the percentage of emergency department (ED) visits for patients 18 years of age and older who have multiple high-risk chronic conditions who had a follow-up service within 7 days of the ED visit (8 days total).

Studies show that communication challenges and adverse health outcomes persist because hospitals, including ED providers, face few repercussions for failing to send medical records to patients’ outpatient providers upon admission and following discharge.1

Documentation

Eligible patients refers to those who are 18 years or older on the date of the ED visit AND have two or more chronic conditions diagnosed prior to the ED visit AND visited the ED on or between January 1 and December 24 of the measurement year.

Members may have more than one ED visit. Identify all ED visits between January 1 and December 24 of the measurement year. If a member has more than one ED visit in an 8-day period, include only the first eligible ED visit. Identify ED visits where the member had a chronic condition prior to the ED visit. The following are eligible chronic condition diagnoses.

Description

COPD and asthma

Heart failure

Alzheimer’s disease and related disorders

Acute myocardial infarction

Chronic kidney disease

Atrial fibrillation

Depression

Stroke and transient ischemic attack

9.1

9.2

9.3

9.4

9.5

Code(s)

A follow-up service within 7 days after the ED visit (8 total days). Include visits that occur on the date of the ED visit. The following meet criteria for follow-up:

• An outpatient visit

• A telehealth visit

• Transitional care management services

• Case management visit

• Complex care management services

• An outpatient or telehealth behavioral health visit

• An intensive outpatient encounter or partial hospitalization

• A community mental health center visit

• Electroconvulsive therapy

• A substance use disorder service

• A substance use disorder service

Additional Measures: Follow-Up After ED Visit for People With Multiple High-Risk Chronic Conditions (FMC)

Eligible Codes

Description

Substance Use Disorder Service

E-Visit or Virtual Check-In

Exclusions

• ED visits that result in an inpatient stay

CPT 99408, 99409

HCPCS

Code(s)

G0396, G0397, G04443, H0001, H0005, H0007, H0015, H0016, H0022, H0047, H0050, H2035, H2036, T1006, T1012

CPT 99423, 99444, 99457

POS G0071, G2010, G2012, G2061, G2062, G2063

9.1 9.2 9.3 9.4 9.5

• ED visits followed by admission to an acute or non-acute inpatient care setting on the date of the ED visit or within 7 days after the ED visit, regardless of the principal diagnosis for admission

Note: An ED visit billed on the same claim as an inpatient stay is considered a visit that resulted in an inpatient stay

Common Errors

• Communication challenges or not actively checking and receiving ED medical records upon admission and following discharge

• Not having an established transition of care protocol within the practice

• Reviewing ED status weekly or waiting for claims data notification

How to Improve Score

• Sign up for the Florida Health Information Exchange service, through Audacious Inquiry, to receive real-time updates when a patient is seen at an emergency department within the state of Florida.

• Utilize EPIC Remote Access to monitor daily patients who are in the ED or have been admitted to the hospital.

• Schedule post ED follow-up visit within 3-5 days after discharge.

• Provide a visit summary with what was discussed during the PCP transition visit and clear instructions on changes that need immediate attention.

• Establish a care transition workflow as part of daily process within your practice along with a Transition Coach role (a specially trained nurse/ MA).

• Establish templates or order sets within EHR system for specific visit type and attributable codes.

References:

1. Health Affairs. 2012. Health Policy Brief: Care Transitions. September 13, 2012. Retrieved July 12, 2016, from https://www.healthaffairs.org/do/10.1377/hpb20120913.327236/full/healthpolicybrief_76.pdf

2. Staff, N. C. Q. A. (2020, December 28).

Follow-up after emergency department visit for people with high-risk multiple chronic conditions. NCQA. Retrieved May 4, 2022, from https://www.ncqa.org/hedis/measures/follow-up-after-emergency-department-visit-for-people-with-high-risk-multiple-chronic-conditions/

Additional Measures: Follow-Up After ED Visit for People With Multiple High-Risk Chronic Conditions (FMC)