dQM QICore Content Implementation Guide
2025.0.0 - CI Build
dQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2025.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/dqm-content-qicore-2025/ and changes regularly. See the Directory of published versions
Official URL: https://madie.cms.gov/Measure/CMS177FHIRChildMDDSuicideAssmt | Version: 1.0.000 | |||
Active as of 2025-08-22 | Responsible: Mathematica | Computable Name: CMS177FHIRChildMDDSuicideAssmt | ||
Other Identifiers: Short Name: CMS177FHIR (use: usual, ), UUID:50d1dfcf-e2bf-41e8-bc1c-c607e5a09e79 (use: official, ), UUID:2df449e3-aa29-4cbb-b042-9c6e583f200a (use: official, ), Endorser: 1365e (use: official, ), Publisher: 177FHIR (use: official, ) | ||||
Copyright/Legal: Copyright 2025 Mathematica Inc. All Rights Reserved. The PCPI and American Medical Association’s (AMA) significant past efforts and contributions to the development and updating of the Measure is acknowledged. |
Percentage of patient visits for those patients aged 6 through 16 at the start of the measurement period with a diagnosis of major depressive disorder (MDD) with an assessment for suicide risk
Metadata | |
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Title | Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentFHIR |
Version | 1.0.000 |
Short Name | CMS177FHIR |
GUID (Version Independent) | urn:uuid:50d1dfcf-e2bf-41e8-bc1c-c607e5a09e79 |
GUID (Version Specific) | urn:uuid:2df449e3-aa29-4cbb-b042-9c6e583f200a |
CMS Identifier | 177FHIR |
CMS Consensus Based Entity Identifier | 1365e |
Effective Period | 2026-01-01 through 2026-12-31 |
Steward (Publisher) | Mathematica |
Developer | Mathematica |
Description | Percentage of patient visits for those patients aged 6 through 16 at the start of the measurement period with a diagnosis of major depressive disorder (MDD) with an assessment for suicide risk |
Copyright | Copyright 2025 Mathematica Inc. All Rights Reserved. The PCPI and American Medical Association's (AMA) significant past efforts and contributions to the development and updating of the Measure is acknowledged. |
Disclaimer | The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measure require a license agreement between the user and Mathematica. Neither Mathematica, the PCPI, nor the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor their members shall be responsible for any use of the Measure. Mathematica encourages use of the Measure by other health care professionals, where appropriate. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding may be contained in the Measure specifications for convenience. A license agreement must be entered prior to a third party's use of Current Procedural Terminology (CPT[R]) or other proprietary code set contained in the Measure. Any other use of CPT or other coding by a third party is strictly prohibited. Mathematica, the AMA, and former members of the PCPI disclaim all liability for use or accuracy of any CPT(R) or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R]. |
Rationale | Research has shown that youth with major depressive disorder (MDD) are at a high risk for suicide attempts and completion - among the most significant and devastating sequelae of the disease (Fontanella et al., 2020). Suicide risk is a critical consideration in children and adolescents with MDD, and an important aspect of care that should be assessed at each visit and subsequently managed to minimize that risk. Additionally, the importance of the assessments is underscored by research (Fontanella et al., 2020; Luoma, Martin, & Pearson, 2002) that indicates that many individuals who die by suicide do make contact with primary care providers and mental health services beforehand. More specifically, approximately 15% of suicide victims aged 35 years or younger had seen a mental health professional within 1 month of suicide while approximately 23% had seen a primary care provider within 1 month of suicide (Luoma, Martin, & Pearson, 2002). A recent analysis of depression severity and suicidal ideation symptom trajectories (Witt et al., 2021) found that suicidal ideation among children and young adults (15-25 years) might not improve with depression symptom severity. This evidence suggests the potential utility of continued suicide risk screening even after improvements in depression symptoms. Better assessment and identification of suicide risk in the health care setting should lead to improved connection to treatment and reduction in suicide attempts and deaths by suicide. |
Clinical Recommendation Statement | The evaluation must include assessment for the presence of harm to self or others (Birmaher et al., 2007). Suicidal behavior exists along a continuum from passive thoughts of death to a clearly developed plan and intent to carry out that plan. Because depression is closely associated with suicidal thoughts and behavior, it is imperative to evaluate these symptoms at the initial and subsequent assessments. For this purpose, low burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can be used. Also, it is crucial to evaluate the risk (e.g., age, sex, stressors, comorbid conditions, hopelessness, impulsivity) and protective factors (e.g., religious belief, concern not to hurt family) that might influence the desire to attempt suicide. The risk for suicidal behavior increases if there is a history of suicide attempts, comorbid psychiatric disorders (e.g., disruptive disorders, substance abuse), impulsivity and aggression, availability of lethal agents (e.g., firearms), exposure to negative events (e.g., physical or sexual abuse, violence), and a family history of suicidal behavior (Birmaher et al., 2007). A careful and ongoing evaluation of suicide risk is necessary for all patients with major depressive disorder (Category I). Such an assessment includes specific inquiry about suicidal thoughts, intent, plans, means, and behaviors; identification of specific psychiatric symptoms (e.g., psychosis, severe anxiety, substance use) or general medical conditions that may increase the likelihood of acting on suicidal ideas; assessment of past and, particularly, recent suicidal behavior; delineation of current stressors and potential protective factors (e.g., positive reasons for living, strong social support); and identification of any family history of suicide or mental illness (Category I) (Gelenberg et al., 2010). |
Citation | American Academy of Child and Adolescent Psychiatry. (2007). Practice parameter for the assessment and treatment of children and adolescents with depressive disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 46(11), 1503-1526. doi:10.1097/chi.0b013e318145ae1c |
Citation | American Psychiatric Association. (2010). Practice guideline for the treatment of patients with major depressive disorder. 3rd edition. Retrieved from http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf (This guideline was reaffirmed in 2015.) |
Citation | Fontanella, C. A., Warner, L. A., Steelesmith, D., Bridge, J. A., Sweeney, H. A., Campo, J. V. (2020). Clinical profiles and health services patterns of Medicaid-enrolled youths who died by suicide. Journal of the American Medical Association Pediatrics, 174(5), 470-477. doi:10.1001/jamapediatrics.2020.0002 |
Citation | Luoma, J. B., Martin, C. E., & Pearson, J. L. (2002). Contact with mental health and primary care providers before suicide: A review of the evidence. American Journal of Psychiatry, 159(6), 909-916. doi:10.1176/appi.ajp.159.6.909 |
Citation | Witt, K., Madsen, T., Berk, M., Dean, O., Chanen, A., McGorry, P.D., Cotton, S., Davey, C.G., Hetrick, S. (2021). Trajectories of change in depression symptoms and suicidal ideation over the course of evidence-based treatment for depression: Secondary analysis of a randomized controlled trial of cognitive behavioral therapy plus fluoxetine in young people. Australian and New Zealand Journal of Psychiatry, 55(5), 506-516. doi:10.1177/0004867421998763 |
Definition | Numerator Definition: The specific type and magnitude of the suicide risk assessment is intended to be at the discretion of the individual clinician and should be specific to the needs of the patient. At a minimum, suicide risk assessment should evaluate:
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Definition | Numerator Definition: Low burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can also be used. Because no validated assessment tool or instrument fully meets the aforementioned requirements for the suicide risk assessment, individual tools or instruments have not been explicitly included in coding. |
Guidance (Usage) | This dQM is an episode-based measure. An episode is defined as each eligible encounter for major depressive disorder (MDD) during the measurement period. A suicide risk assessment should be performed at every visit for MDD during the measurement period. In recognition of the growing use of integrated and team-based care, the diagnosis of depression and the assessment for suicide risk need not be performed by the same provider or clinician. Suicide risk assessments completed via telehealth services can also meet numerator performance. Use of a standardized tool(s) or instrument(s) to assess suicide risk will meet numerator performance, so long as the minimum criteria noted is evaluated. Standardized tools can be mapped to the code "Suicide risk assessment (procedure)" included in the numerator logic, as no individual suicide risk assessment tool or instrument would satisfy the requirements alone. This FHIR-based measure has been derived from the QDM-based measure: CMS177v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html). |
Measure Group (Rate) (ID: Group_1) | |
Basis | Encounter |
Scoring | [http://terminology.hl7.org/CodeSystem/measure-scoring#proportion: 'Proportion'] |
Type | [http://terminology.hl7.org/CodeSystem/measure-type#process: 'Process'] |
Rate Aggregation | None |
Improvement Notation | [http://terminology.hl7.org/CodeSystem/measure-improvement-notation#increase: 'Increased score indicates improvement'] |
Initial Population |
ID: InitialPopulation_1
Description: All patient visits for those patients aged 6 through 16 at the start of the measurement period with a diagnosis of major depressive disorder Logic Definition: Initial Population |
Denominator |
ID: Denominator_1
Description: Equals Initial Population Logic Definition: Denominator |
Numerator |
ID: Numerator_1
Description: Patient visits with an assessment for suicide risk Logic Definition: Numerator |
Supplemental Data Guidance | For every patient evaluated by this measure also identify payer, race, ethnicity and sex |
Supplemental Data Elements | |
Supplemental Data Element |
ID: sde-ethnicity
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Ethnicity Logic Definition: SDE Ethnicity |
Supplemental Data Element |
ID: sde-race
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Race Logic Definition: SDE Race |
Supplemental Data Element |
ID: sde-sex
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Sex Logic Definition: SDE Sex |
Supplemental Data Element |
ID: sde-payer
Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Payer Logic Definition: SDE Payer |
Measure Logic | |
Primary Library | https://madie.cms.gov/Library/CMS177FHIRChildMDDSuicideAssmt |
Contents |
Population Criteria
Logic Definitions Terminology Dependencies Data Requirements |
Population Criteria | |
Measure Group (Rate) (ID: Group_1) | |
Initial Population | |
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Denominator | |
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Numerator | |
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Logic Definitions | |
Logic Definition | Library Name: SupplementalDataElements |
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Logic Definition | Library Name: SupplementalDataElements |
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Logic Definition | Library Name: SupplementalDataElements |
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Logic Definition | Library Name: SupplementalDataElements |
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Logic Definition | Library Name: CMS177FHIRChildMDDSuicideAssmt |
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Logic Definition | Library Name: CMS177FHIRChildMDDSuicideAssmt |
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Logic Definition | Library Name: CMS177FHIRChildMDDSuicideAssmt |
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Logic Definition | Library Name: CMS177FHIRChildMDDSuicideAssmt |
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Logic Definition | Library Name: CMS177FHIRChildMDDSuicideAssmt |
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Logic Definition | Library Name: CMS177FHIRChildMDDSuicideAssmt |
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Logic Definition | Library Name: CMS177FHIRChildMDDSuicideAssmt |
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Logic Definition | Library Name: CMS177FHIRChildMDDSuicideAssmt |
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Logic Definition | Library Name: CMS177FHIRChildMDDSuicideAssmt |
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Logic Definition | Library Name: CMS177FHIRChildMDDSuicideAssmt |
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Logic Definition | Library Name: CMS177FHIRChildMDDSuicideAssmt |
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Logic Definition | Library Name: CMS177FHIRChildMDDSuicideAssmt |
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Logic Definition | Library Name: FHIRHelpers |
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Logic Definition | Library Name: FHIRHelpers |
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Logic Definition | Library Name: FHIRHelpers |
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Logic Definition | Library Name: FHIRHelpers |
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Logic Definition | Library Name: QICoreCommon |
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Logic Definition | Library Name: QICoreCommon |
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Logic Definition | Library Name: QICoreCommon |
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Terminology | |
Code System |
Description: Code system SNOMEDCT
Resource: http://snomed.info/sct Canonical URL: http://snomed.info/sct |
Value Set |
Description: Value set Office Visit
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001 |
Value Set |
Description: Value set Outpatient Consultation
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008 |
Value Set |
Description: Value set Psych Visit Diagnostic Evaluation
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492 |
Value Set |
Description: Value set Psych Visit for Family Psychotherapy
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1018 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1018 |
Value Set |
Description: Value set Psych Visit Psychotherapy
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1496 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1496 |
Value Set |
Description: Value set Psychoanalysis
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1141 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1141 |
Value Set |
Description: Value set Group Psychotherapy
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1187 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1187 |
Value Set |
Description: Value set Telephone Visits
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080 |
Value Set |
Description: Value set Major Depressive Disorder Active
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1491 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1491 |
Value Set |
Description: Value set Payer Type
Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 |
Direct Reference Code |
Display: Male (finding)
Code: 248153007 System: http://snomed.info/sct |
Direct Reference Code |
Display: Female (finding)
Code: 248152002 System: http://snomed.info/sct |
Direct Reference Code |
Display: Suicide risk assessment (procedure)
Code: 225337009 System: http://snomed.info/sct |
Dependencies | |
Dependency |
Description: QICore model information
Resource: http://hl7.org/fhir/Library/QICore-ModelInfo Canonical URL: http://hl7.org/fhir/Library/QICore-ModelInfo |
Dependency |
Description: Library SDE
Resource: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000 Canonical URL: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000 |
Dependency |
Description: Library FHIRHelpers
Resource: https://madie.cms.gov/Library/FHIRHelpers|4.4.000 Canonical URL: https://madie.cms.gov/Library/FHIRHelpers|4.4.000 |
Dependency |
Description: Library QICoreCommon
Resource: https://madie.cms.gov/Library/QICoreCommon|4.0.000 Canonical URL: https://madie.cms.gov/Library/QICoreCommon|4.0.000 |
Data Requirements | |
Data Requirement |
Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient Must Support Elements: extension, birthDate, birthDate.value, url |
Data Requirement |
Type: Resource
Profile(s): http://hl7.org/fhir/StructureDefinition/Resource Must Support Elements: id, id.value |
Data Requirement |
Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, status, status.value, period, reasonReference, reasonCode Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001 |
Data Requirement |
Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, status, status.value, period, reasonReference, reasonCode Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008 |
Data Requirement |
Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, status, status.value, period, reasonReference, reasonCode Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1492 |
Data Requirement |
Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, status, status.value, period, reasonReference, reasonCode Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1018 |
Data Requirement |
Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, status, status.value, period, reasonReference, reasonCode Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1496 |
Data Requirement |
Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, status, status.value, period, reasonReference, reasonCode Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1141 |
Data Requirement |
Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, status, status.value, period, reasonReference, reasonCode Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1187 |
Data Requirement |
Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, status, status.value, period, reasonReference, reasonCode Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080 |
Data Requirement |
Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1491 |
Data Requirement |
Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1491 |
Data Requirement |
Type: Procedure
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure Must Support Elements: code, status, status.value, performed Code Filter(s): Path: code Code(s): http://snomed.info/sct#225337009: 'Suicide risk assessment (procedure)' |
Data Requirement |
Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment Must Support Elements: code Code Filter(s): Path: code Code(s): http://snomed.info/sct#225337009: 'Suicide risk assessment (procedure)' |
Data Requirement |
Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-clinical-result Must Support Elements: code Code Filter(s): Path: code Code(s): http://snomed.info/sct#225337009: 'Suicide risk assessment (procedure)' |
Data Requirement |
Type: Coverage
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage Must Support Elements: type, period Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 |
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