Overview

The Depression Remission at Six Months (DEP-REM-6) measure evaluates whether clients diagnosed with Major Depressive Disorder (MDD) or Dysthymia achieve remission within six months of an initial elevated PHQ-9 score. Remission is defined as a PHQ-9 score less than 5, documented within a specific time window following the Index Event Date (IED). The measure includes specific inclusion and exclusion criteria for both numerator and denominator populations and is assessed annually.

Measurement Year Inclusion

• Client must have had at least one qualifying encounter during the Measurement Year (MY).
  • Have an active diagnosis of Major Depression or Dysthymia (ICD-10-CM): F32.0, F32.1, F32.2, F32.3, F32.4, F32.5, F32.9, F33.0, F33.1, F33.2, F33.3, F33.40, F33.41, F33.42, F33.9, F34.1.
  • At a client encounter during the Measurement Year (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, G0402, G0438, G0439, 99384*, 99394.

Age Requirement

• Client must be 12 years or older at the time of the Index Event Date (IED). 

Clinical Criteria

• Client must have an active diagnosis of Major Depressive Disorder (MDD) documented during the MY.
• Client must have a PHQ-9 (PRO-0035) score greater than 9, documented on the same date as the diagnosis or up to 7 days prior to the encounter.
• The PHQ score must be recorded within the MY.

Index Event Date Rule

• Date on which first instance of elevated PHQ-9 (PRO-0035) is greater than 9 and diagnosis of Depression or Dysthymia during MY. Clients can be screened up to 7 days prior to encounter.

• IMPORTANT: There can only be one Index Event per Measurement Year (MY). It is recommended to always take the first Index Event. 

Numerator Criteria

Inclusion

• Client must be in the denominator population.
• Client must have a PHQ-9 (PRO-0035) score less than 5 documented within the six-month remission window.
• Performance Met:
  • Client has a PHQ-9 score less than 5 documented within the six-month window.

• NOTE: If the last PHQ-9 form (the most recent PRO-0035) has a score less than 5, falls within the Remission Period, as defined by the IED (6 months +/- 60 days), then the Client will be counted in the numerator.

• NOTE: If a PHQ-9 form with a score of less than 5 occurs, but there is also a more recent PHQ-9 form with a score higher than 5, the Client will not be included in the numerator. This does not affect the denominator calculation. 

Denominator Criteria

Inclusion

• Client must be 12 years or older at the time of the IED.
• Client must have an active diagnosis of the Major Depressive Disorder (MDD).
• Client must have a PHQ-9 (PRO-0035) score greater than 9 documented on the IED, which occurs during the MY. 

Exclusion

• Active Bipolar Disorder at any time during the Measurement Period (MP).
• Active Personality Disorder at any time during the MP.
• Active Schizophrenia or Psychotic Disorder at any time during the MP.
• Active Pervasive Developmental Disorder at any time during the MP.
• Client death occurring during the MP.
• Client received hospice or palliative care services during the MP. 

Measurement Period Definition

• The MP for the denominator is the Measurement Year (MY).
• The MP for exclusions extends through the numerator MP, which begins four months after the start of the MY and ends eight months after the end of the MY.