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2019, Rev. 1 BH:Adult and Geriatric Psychiatry Adult and Geriatric Psychiatry InterQual® 2019, Rev. 1 BH:Adult and Geriatric Psychiatry Adult and Geriatric Psychiatry Overview Select Level of Care Intensive Outpatient Program (1, 2) Notes InterQual® criteria (IQ) is confidential and proprietary information and is being provided to you solely as it pertains to the information requested. IQ may contain advanced clinical knowledge which we recommend you discuss with your physician upon disclosure to you. Use permitted by and subject to license with Change Healthcare LLC and/or one of its subsidiaries. IQ reflects clinical interpretations and analyses and cannot alone either (a) resolve medical ambiguities of particular situations; or (b) provide the sole basis for definitive decisions. IQ is intended solely for use as screening guidelines with respect to medical appropriateness of healthcare services. All ultimate care decisions are strictly and solely the obligation and responsibility of your health care provider. © 2019 Change Healthcare LLC and/or one of its subsidiaries. All Rights Reserved. Overview Informational Notes The Adult and Geriatric Psychiatry Criteria are for the review of patients who are ages 18 and older. InterQual® content contains numerous references to gender. Depending on the context, these references may refer to either genotypic or phenotypic gender. At the individual patient level, a variety of factors, including, but not limited to, gender identity and gender reassignment via surgery or hormonal manipulation, may affect the applicability of some InterQual criteria. This is most often the case with genetic testing and procedures that assume the presence of gender−specific anatomy. With these considerations in mind, all references to gender in InterQual have been reviewed and modified when appropriate. InterQual users should carefully consider issues related to patient genotype and anatomy, especially for transgender individuals, when appropriate. InterQual® criteria are derived from the systematic, continuous review and critical appraisal of the most current evidence−based literature and include input from our independent panel of clinical experts. To generate the most appropriate recommendations, a comprehensive literature review of the clinical evidence was conducted. Sources searched included the Agency for Healthcare Research and Quality (AHRQ) Effective Health Care Program, American Psychiatric Association, American Academy of Child and Adolescent Psychiatry, American Psychological Association, American Society of Addiction Medicine, Centers for Medicare and Medicaid Services, Choosing Wisely, Cochrane Library, National Institute of Alcohol Abuse and Alcoholism, National Institute for Health and Care Excellence, National Institute on Drug Abuse, PubMed, Substance Abuse and Mental Health Services Administration, and other key medical societies. The Association of Ambulatory Behavioral Healthcare, Commission on Accreditation of Rehabilitation Facilities, and the Joint Commission were also searched. Other medical literature databases, medical content providers, data sources, regulatory body websites, and specialty society resources may also have been utilized. Relevant studies were assessed for risk of bias following principles described in the Cochrane Handbook. The resulting evidence was assessed for consistency, directness, precision, effect size, and publication bias. Observational trials were also evaluated for the presence of a dose−response gradient and the likely effect of plausible confounders. Licensed for use exclusively by Beacon Health Page 1 of 15 InterQual® 2019, Rev. 1 BH:Adult and Geriatric Psychiatry Adult and Geriatric Psychiatry INTENSIVE OUTPATIENT PROGRAM, One: (1, 2) Episode Day 1, All: Functional impairment, ≥ One: (3) Eating disorder, Both: (4) − Transfer from Residential Treatment Center within last week − Difficulty implementing healthy eating principles (4) Moderate in severity and change in baseline within last month, ≥ One: Impairment in primary role performance, ≥ One: − Absent 4 or more consecutive days from school or work (5, 6) − Placed on educational or employment performance plan and having difficulty meeting expectations − Self−employed and unable to meet work obligations − Suspended or placed on leave of absence from work or school − Unemployed or retired and unable to structure daytime hours Impairment in social relations, ≥ One: − Alleged perpetrator of abuse within last month − Arrest or protection order or restraining order due to domestic dispute − Increasing interpersonal conflict (7) − Increasing social alienation or isolation (8) − Precipitating stressful life event within last 3 months (9, 10) − Unable to perform IADLs and not chronic in nature Symptom severity increasing within last week and interfering with daily functioning, ≥ One: − Anxiety disorder and associated symptom (11, 12) − Assaultive or threatening within last 24 hours and able to prevent reoccurrence − Body dysmorphic disorder (13) − Compulsion (14) Co−occurring substance use disorder, ≥ One: (15) − High−risk sexual behaviors (16) − Increasing substance use and unable to apply skills to reduce or prevent use Substance free and high risk of relapse, ≥ One: − Decreased ability to utilize adequate coping strategies (17) − Decreased self−efficacy or motivation to remain abstinent (18) − Increase in individual relapse warning signs (19) − Loss of positive support system or recovery network (20) Distorted thinking, ≥ One: − Misinterpretation of interactions − Paranoia causing verbal or physical altercations with others (21) Depressive disorder or major depressive episode and associated symptom ≥ One: − Excessive or inappropriate guilt (22) − Feelings of worthlessness − Hopelessness − Impaired ability to make decisions − Loss of appetite with weight loss or lack of consistent weight gain − Overeating with persistent weight gain (23) − Psychomotor agitation or retardation (24) − Recurrent thoughts of death − Unable to think clearly or concentrate (25) Disruptive or impulse−control or conduct disorder and associated symptom, ≥ One: − Bullying or intimidating or threatening others − Deliberate or vindictive behavior damages property or harms others − Driving at excessive speeds − Fire setting to relieve tension without harm to self or others − Risky substance use − Shoplifting − Stalking − Stealing Eating disorder symptom, ≥ One: − Compulsive exercise daily or most days and persistent weight loss over last 2 weeks Licensed for use exclusively by Beacon Health Page 2 of 15 InterQual® 2019, Rev. 1 BH:Adult and Geriatric Psychiatry Adult and Geriatric Psychiatry − Food rituals and persistent weight loss over last 2 weeks (26) − Preoccupation with food or body or weight gain interferes with IADLs or interpersonal relationships − Purging behavior 1 to 2 times daily on most days (27) − Recent and continuing weight loss and weight greater than 85%(0.85) ideal body weight (28, 29) − Restricting or refusing food intake at one to two meals daily on most days and persistent weight loss over last 2 weeks Emotional dysregulation severe, ≥ One: Angry or impulsive outbursts at least 3 times per week in at least 2 different situations, ≥ One: (30, 31) − Physical outbursts (32) − Verbal outbursts − Extreme mood lability Fire setting history and risk of re−occurrence, ≥ One: − Increased preoccupation − Possession of fire setting material − Hair pulling resulting in tissue damage or systemic infection not attributable to medical cause (33) − Hoarding that causes difficulty in maintaining a safe environment for self or others (34) − Homicidal thoughts increasing without intent or plan Hypomanic symptom, ≥ Two: − Decreased need for sleep − Distractibility (35) − Excessive involvement in activities with potential for negative consequences (36) − Flight of ideas (37) − Grandiosity (38) − Increased talkativeness − Inflated self−esteem − Pressured speech (39) − Increasing difficulty resisting urges to harm self − Nonsuicidal self−injury increasing in frequency or intensity (40, 41) − Obsessions (42) − Posttraumatic stress disorder and associated symptom (43) Psychotic symptom, ≥ One: − Delusions (44) − Disorganized speech or thinking (45) − Disorganized behavior (46) − Hallucinations (47) − Negative symptoms (48) − Sexually inappropriate (49) − Skin picking resulting in tissue damage or systemic infection not attributable to medical cause (50) − Suicidal thoughts increasing without intent or plan − Transportation available (51) Episode Day 2−24, One: Symptom improved and discharge expected today, One: (52) − Patient or caregiver demonstrates ability to manage condition and condition does not require daily monitoring (see Outpatient criteria) Symptom improving or expected to improve and not clinically stable for discharge, Both: Finding within last 5 authorized program days, Both: Functional impairment, ≥ One: − Absent at least one day per week from work or school (6, 53) − Deterioration in care of dependent children or vulnerable adults Difficulty implementing substance free living skills, ≥ One: − Persistent inability to apply effective coping skills in high risk situations (17) − Substance use and continued motivation (54) − Unable to ask for help or develop positive supports − Unable to disengage from substance abusing peer group − Easily frustrated − Increasing social isolation or alienation (8) Interpersonal conflict, ≥ One: Licensed for use exclusively by Beacon Health Page 3 of 15 InterQual® 2019, Rev. 1 BH:Adult and Geriatric Psychiatry Adult and Geriatric Psychiatry
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