CMS136v12 – Follow-Up Care for Children Prescribed ADHD Medication (ADD)

Children 6-12 years of age as of the Intake Period who were prescribed an ADHD medication during the Intake Period and who had a visit during the measurement period. Children are removed if they were actively on ADHD medication in the 120 days prior to the IPSD, or had an acute inpatient stay with a principal diagnosis of mental, behavioral or neurodevelopmental disorder during the Initiation Phase.

Intake Period: The twelve-month period starting March 1 of the year prior to the measurement period and ending the last calendar day of February of the measurement period.

A qualifying visit in this case can include any of the following:

• Office Visit
• Home Healthcare Services
• Preventive Care, Established Office Visit, 0 to 17
• Preventive Care Services, Initial Office Visit, 0 to 17

Patients who had at least one visit with a practitioner with prescribing authority during the Initiation Phase.

Initiation Phase: The 30 days following the IPSD.

Children 6-12 years of age as of the Intake period who were prescribed an ADHD medication during the Intake Period and remained on the medication for at least 210 days during the 301-day period, beginning on the IPSD through 300 days after the IPSD, and who had a visit during the measurement period. Children are removed if they were actively on ADHD medication in the 120 days prior to the IPSD, or had an acute inpatient stay with a principal diagnosis of mental, behavioral or neurodevelopmental disorder during the Continuation and Maintenance Phase.

Continuation and Maintenance Phase: The 300 days following the IPSD.

A qualifying visit in this case can include any of the following:

• Office Visit
• Home Healthcare Services
• Preventive Care, Established Office Visit, 0 to 17
• Preventive Care Services, Initial Office Visit, 0 to 17

Patients who had at least one visit with a practitioner with prescribing authority during the Initiation Phase, and at least two follow-up visits during the 31-300 days after the IPSD (Index Prescription Start Date).

Index Prescription Start Date (IPSD): The earliest prescription date for an ADHD medication where the date is in the Intake Period and an ADHD medication was not prescribed during the 120 days prior.

A qualifying encounter in both cases can include any of the following:

• Office Visit
• Initial Hospital Observation Care
• Preventive Care Services Group Counseling
• Behavioral Health Follow up Visit
• Preventive Care Services Individual Counseling
• Psychotherapy and Pharmacologic Management (for patients in Ambulatory setting)
• Observation care discharge day management
• Outpatient Consultation
• Home Healthcare Services
• Preventive Care Services, Initial Office Visit, 0 to 17
• Preventive Care, Established Office Visit, 0 to 17
• Psych Visit Diagnostic Evaluation
• Psych Visit Psychotherapy
• Telephone Visits

Patients who fall in the following two categories are not included in the denominator:

• Patients diagnosed with narcolepsy at any point in their history or during the measurement period.
• Patients who are in hospice care for any part of the measurement period.

Patients who fall in the following two categories are not included in the denominator:

• Patients diagnosed with narcolepsy at any point in their history or during the measurement period.
• Patients who are in hospice care for any part of the measurement period.

For Denominators 1 & 2:

• To record an encounter, navigate to Patient > Provider Notes > Create Superbill. Under the ‘Procedures-CPTs’ heading, enter one of these encounter codes:

• For documenting ADHD medication, use the workflow Patient > Provider Notes > Prescription or Patient > Provider Notes > Medications. Click ‘Add’ and search for the relevant medication. Log in the required details and click ‘Save’.

For Numerators 1 & 2:

• To record an encounter, navigate to Patient > Provider Notes > Create Superbill.
• To document the ADHD medication, use the workflow Patient > Provider Notes > Prescription or Patient > Provider Notes > Medications.

For Denominator Exclusions:

• The narcolepsy diagnosis can be documented via Patient > Provider Notes > Diagnoses or as part of a patient’s medical history through Patient > Clinical > History > +Medical. Search for the diagnosis and fill out the relevant details. Once done, click ‘Save’.

• To document a patient receiving hospice care, navigate to Patient > Provider Notes > Evaluations. Hospice Care can also be recorded by the workflow Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, add the relevant hospice care code.