HEDIS® Tip Sheet

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

Line of business: BlueAlliance (Commercial) & BlueAlliance Care+ (Medicaid)

Measure Description

The percentage of emergency department (ED) visits for members 6 years of age and older with a principal diagnosis of mental illness or any diagnosis of intentional self-harm, who had a follow-up visit for mental illness. 

Two rates are reported:

  • The percentage of ED visits wherein the member received follow-up care within 30 days of the ED visit (31 days total)
  • The percentage of ED visits wherein the member received follow-up care within 7 days of the ED visit (8 days total)
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Compliance for 7-Day and 30-Day Follow-Up

Any of the following services with any practitioner, for any diagnosis of a mental health disorder may count as a follow-up visit:

  • An outpatient visit.
  • An intensive outpatient visit or partial hospitalization.
  • A community mental health center visit.
  • Electroconvulsive therapy.
  • An observation visit.
  • A telehealth visit.
  • A telephone visit.
  • An e-visit, or virtual check-in.
  • Psychiatric collaborative care management
  • Peer support service
  • Psychiatric residential treatment
  • A visit in a behavioral healthcare setting
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Notes

  • A member can be included in the measure more than once as the denominator is based on ED visits.
  • If the member has more than one qualifying ED visit within a 31-day period, include only the first eligible visit.
  • Follow-up visits must have any diagnosis of a mental health disorder
  • Follow-up visits that occur on the same day as the ED visit can count toward compliance.
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Exclusions

  • ED visits that result in an inpatient stay.
  • ED visits followed by admission to an acute or nonacute inpatient setting excluding residential psychiatric treatment, on the date of the ED visit or within 30 days of the ED visit regardless of the primary reason for the admission.
  • Members in hospice during the measurement year.
  • Members who died during the measurement year.
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Best Practices

  • Encourage use of telehealth appointments for follow-up visits.
  • Educate patients on the importance of follow-up and adhering to treatment recommendations. 
  • Schedule follow up visits as soon as possible and educate patients, utilizing teach back methods, on the importance of keeping follow-up appointments. 
  • Include caregivers, if applicable, in understanding discharge and follow-up instructions. 
  • Utilize EMR flags and reporting reports to assist in tracking patients in need of follow-up visits and those who cancel or do not show up for appointments so appropriate outreach and referrals can be made. Assist members with scheduling an in-person or telehealth visit within 7 days of an ED visit.
  • Consider referrals to case managers or social workers to help patients coordinate care.
  • Provide mental health assessments at PCP visits.
  • Refer patients to community resources for support when appropriate.

Coding Disclaimer

The analysis of any medical coding question related to a measure is dependent on the measure’s technical specifications including the factual situations present related to the member, the practice, the professionals, and the medical services provided.

Questions  

Should you have specific coding or other questions related to the measure, please send your questions to BlueAlliance@bcbsnd.com.

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Updated 1/22/2025