Q150 – 152: Psychiatric Impairment / Disorder

The purpose of this section is to capture any impairments or disorders present during the current reporting period, regardless of treatment or intervention, unless otherwise specified. Review each impairment or disorder description to determine whether treatment or intervention is required for reporting the condition.

*Reporting Multiple Psychiatric Impairments / Disorders
Complete Date of psychiatric impairment / disorder onset through Specify psychiatric impairment / disorder questions to report multiple psychiatric impairments / disorders by adding an additional instance in the FormsNet3^SM application.

Questions 150 – 152: Was a psychiatric impairment / disorder present?

Psychiatric impairment / disorders include depression, anxiety, and post-traumatic stress disorder.

• Depression: A mood disorder resulting in persistent feeling of sadness and loss of interest. Common treatments include antidepressant, anxiolytic, and antipsychotic medications. Common names include Amitriptyline, Bupropion (Wellbutrin), Buspirone, and Abilify.
• Anxiety: A disorder characterized by feelings of worry, anxiety, or fear which are strong enough to interfere with daily activities. Common medications include Duloxetine (Cymbalta), Diazepam (Valium), Buspirone, Pregabalin (Lyrica).
• Post-traumatic stress disorder (PTSD): A condition triggered by seeing or experiencing a traumatic event.

Indicate if depression, anxiety, or PTSD, requiring treatment, was present in the current reporting period.

Report Developed if this is the first time the recipient was diagnosed with depression, anxiety, or PTSD, requiring treatment, in the reporting period.

If depression, anxiety, or PTSD, requiring treatment Developed, report the onset date and specify the psychiatric impairment / disorder. If the diagnosis was determined at an outside center and no documentation of a clinical, pathological, or laboratory assessment is available, the dictated date of diagnosis within a physician note may be reported.

Do not report the following:

• A recurrence of depression, anxiety, or PTSD, requiring treatment. Only the first occurrence is captured.
• Depression, anxiety, or PTSD, requiring treatment was diagnosed pre-infusion and persisted into the Day 100 reporting period.
• Depression, anxiety, or PTSD, requiring treatment continued from a previous reporting period into the current reporting period.
  

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

If depression, anxiety, and / or PTSD, requiring treatment, was not present in the current reporting period or unknown if present, select Not present.

Section Updates:

Question Number	Date of Change	Add/Remove/Modify	Description	Reasoning (If applicable)
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