CMS136v13 – Follow-Up Care for Children Prescribed ADHD Medication (ADD)

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

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

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

Patients who had at least one visit with a practitioner with prescribing authority during the Initiation Phase, and at least two follow-up visits on different dates of service 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 numerator visit 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 the relevant encounter code,

• To prescribe 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’.

• Current medication can be documented through Patient > Provider Note > Medications.

Children are not to be included in the denominator if they had an acute inpatient stay with a mental, behavioral and neurodevelopmental disorder. These criteria can be recorded as follows:

• To record an inpatient encounter, head over to Patient > Provider Note > Evaluations. Here, click ‘Add’ and search for the relevant inpatient intervention. From the ‘Status’ drop-down select ‘Performed’ and from the ‘Result’ drop-down select the relevant result. Once done, click ‘Save & Accept’ or ‘Sign & Accept’.

• A disorder can be documented via Patient > Provider Note > Diagnoses. Here, click ‘Add’ and search for the relevant diagnosis. Fill out any details as needed and once done, click ‘Save’. Then click ‘Accept’ to add the diagnosis to the provider note.

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. Here, click ‘Add’ and search for the relevant diagnosis. Fill out any details necessary and once done, click ‘Save’. Then click ‘Accept’ to add the diagnosis to the provider note.

• To document that a patient is receiving hospice care outside of a hospital or long-term care facility, navigate to Patient > Provider Note > Evaluations. Use the below mentioned codes to order or perform an intervention:
  • 385763009: Hospice Care (Regime/Therapy)
  • 385765002: Hospice Care Management (Procedure)

• To document an inpatient encounter, navigate to Patient > Provider Note > Evaluations.
• To document a hospice care assessment, follow the workflow Patient > Provider Note > Evaluations. Click ‘Add’ and search for ‘Hospice Care [Minimum Data Set]’. Then select ‘Performed’ from the ‘Status’ dropdown and ‘Yes’ from the ‘Result’ field.

• A hospice encounter can be documented through Patient > Provider Note > Evaluations or Patient > Provider Note > Create Superbill.