All female patients of childbearing potential (12 - 44 years old) diagnosed with epilepsy who were counseled or referred for counseling for how epilepsy and its treatment may affect contraception OR pregnancy at least once a year
This measure is to be submitted a minimum of once per performance period for patients with a diagnosis of epilepsy during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.
Measure Submission Type:
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
All females of childbearing potential (12-44 years old) with a diagnosis of epilepsy
Unable to Bear Children – For the purposes of this measure, this includes patients who are pre-menstrual, post-menopausal, surgically sterile, or have reproductive organs absent.
Denominator Criteria (Eligible Cases):
All females age 12-44 years old
Diagnosis for Epilepsy (ICD-10-CM): G40.A09, G40.A19, G40.109, G40.119, G40.209, G40.219, G40.309, G40.409, G40.411, G40.822, G40.824, G40.909
Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215
Telehealth Modifier: GQ, GT, 95, POS 02
Female Patients Unable to Bear Children: M1016
Female patients or caregivers counseled at least once a year about how epilepsy and its treatment may affect contraception OR pregnancy
Counseling – Should include a discussion about folic acid supplementation, contraception, potential anti-seizure medications effect(s) on pregnancy, safe pregnancies, and breastfeeding.
If patient has a diagnosis of neurodevelopmental disorder, encephalopathy, hydrocephalus, brain injury, cerebral palsy, severe cognitive impairment, or severe intellectual disability submit code 4340F with 1P.
NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the denominator eligible encounter.
Performance Met: Counseling for women of childbearing potential with epilepsy (4340F)
Denominator Exception: Documentation of medical reason(s) why counseling was not performed for women of childbearing potential with epilepsy (4340F with 1P)
Performance Not Met: Counseling about epilepsy specific safety issues provided to patient or caregiver was not performed, reason not otherwise specified (4340F with 8P)