Defining Positive vs. Negative and Eligibility

According to CMS, positive and negative as they pertain to clinical depression documentation are defined as:3

  • Positive – Based on the scoring and interpretation of the specific standardized tool used, and through discussion during the patient visit, a health professional has determined that the patient is deemed positive for signs of depression
  • Negative – Based on the scoring and interpretation of the specific standardized tool used, and through discussion during the patient visit, a health professional has determined that the patient is deemed negative for signs of depression

Additionally, not all patients will be eligible for follow-up or screening, even if they are otherwise eligible for the measure. The following criteria are used to determine if a patient is not eligible for follow-up or screening:3


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  • Not eligible for follow-up The patient is not eligible for a follow-up plan, or it is not appropriate for the patient to undergo treatment for depression because such treatment is medically contraindicated
  • Not eligible for screening – The patient is not eligible for depression screening if one or more of the following reasons are documented in the patient’s medical record:
    • Patient refuses to participate
    • Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status
    • Situations where the patient’s motivation to improve may impact the accuracy of results of nationally recognized standardized depression assessment tools. For example: certain court appointed cases
    • Patient was referred with a diagnosis of depression
    • Patient has been participating in on-going treatment with screening of clinical depression in a preceding reporting period
    • Severe mental and/or physical incapacity where the person is unable to express himself/herself in a manner understood by others. For example: cases such as delirium or severe cognitive impairment, where depression cannot be accurately assessed through use of nationally recognized standardized depression assessment tools

Justification for any of these findings should be documented in the patient’s medical record.3  

Figure 2 gives an overview of the decision tree users should follow when reporting clinical depression screening and follow-up data to CROWNWeb. (Image courtesy of the ESRD QIP.)


Figure 2: Clinical Depression Screening and Follow-up Decision Tree.