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2020 MIPS Measure #268: Epilepsy: Counseling for Women of Childbearing Potential with Epilepsy

Quality ID

268

NQF

1814

High Priority Measure

No

Specifications

Registry

Measure Type

Process

Specialty

Neurology

Measure Description

Percentage of all patients of childbearing potential (12 years and older) diagnosed with epilepsy who were counseled at least once a year about how epilepsy and its treatment may affect contraception and pregnancy

 

Instructions

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.

 

Denominator

All females of childbearing potential (12years and older) with a diagnosis of epilepsy

Definition:

Female 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, and is represented by code M1016.

Denominator Criteria (Eligible Cases):

All females age 12 years and older

AND

Diagnosis for Epilepsy (ICD-10-CM): G40.001, G40.009, G40.011, G40.019, G40.101, G40.109, G40.111, G40.119, G40.201, G40.209, G40.211, G40.219, G40.301, G40.309, G40.311, G40.319, G40.401, G40.409, G40.411, G40.419, G40.501, G40.509, G40.801, G40.802, G40.803, G40.804, G40.811, G40.812, G40.813, G40.814, G40.821, G40.822, G40.823, G40.824, G40.901, G40.909, G40.911, G40.919, G40.A01, G40.A09, G40.A11, G40.A19, G40.B01, G40.B09, G40.B11, G40.B19

AND

Patient encounter during the performance period (CPT): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

AND NOT

DENOMINATOR EXCLUSION:

Female Patients Unable to Bear Children: M1016

 

Numerator

Female patients or caregivers counseled at least once a year about how epilepsy and its treatment may affect contraception and pregnancy

Definition:

Counseling – Counseling must include a discussion of at least two of the following three counseling topics:

• Need for folic acid supplementation,
• Drug to drug interactions with contraception medication,
• Potential anti-seizure medications effect(s) on fetal/child development and/or pregnancy.

Numerator Options:

Performance Met: Counseling for women of childbearing potential with epilepsy (4340F)

OR

Performance Not Met: Counseling about epilepsy specific safety issues provided to patient or caregiver was not performed, reason not otherwise specified (4340F with 8P)

 

Rationale

Epilepsy is associated with reduced fertility, increased pregnancy risks, and risks for malformations in the infant. Treatment of seizures with anti-seizure medications may alter hormone levels, render oral contraceptives less effective and may interfere with embryonic and fetal development. Certain anti-seizure medications may have specific malformation risks. Folic acid supplementation, monotherapy for epilepsy, using lower doses of medication when possible, and proper obstetrical, prenatal and pre-pregnancy care all should be discussed with the patient so they understand the risks involved and how to mitigate these risks.

 

Clinical Recommendation Statements

If a woman with epilepsy is of childbearing potential and receives oral contraceptives in conjunction with an enzyme inducing AED [Antiepileptic Drug], THEN decreased effectiveness of oral contraception should be addressed. (higher doses of the oral contraceptive, alternative birth control methods, or change AED). (Level A 2++/Primary) Neurology 2007; 69: 2020-2027

Patients with epilepsy should receive an annual review of information including topics such as: Contraception, family planning, and how pregnancy and menopause may affect seizures (evidence grade C) Neurology 2007; 69: 2020- 2027

Women with epilepsy (WWE) should be counseled that seizure freedom for at least 9 months prior to pregnancy is probably associated with a high rate (84%-92%) of remaining seizure-free during pregnancy. Neurology 2009; 73: 126-132

Women with epilepsy who smoke should be counseled that they possibly have a substantially increased risk of premature contractions and premature labor and delivery during pregnancy. There is possibly a substantially increased risk of premature contractions and premature labor and delivery during pregnancy for WWE who smoke. (Level C) Neurology 2009; 73: 126-132

Counseling of WWE who are contemplating pregnancy should reflect that there is probably no increased risk of reduced cognition in the offspring of WWE not taking AEDs (Level B). Neurology 2009; 73: 142-149

To reduce the risk of MCMs, avoidance of the use of VPA during the first trimester of pregnancy, if possible, may be considered, compared to the use of PHT or LTG. [MCMs=major congenital malformations; VPA=valproate; PHT=phenytoin; LTG=lamotrigine] (Level C) Neurology 2009; 73: 142-149

In order to enable informed decisions and choice, and to reduce misunderstandings, women and girls with epilepsy and their partners, as appropriate, must be given accurate information and counseling about contraception, conception, pregnancy, caring for children and breastfeeding, and menopause. (Level III) NICE 2012

Information about contraception, conception, pregnancy, or menopause should be given to women and girls in advance of sexual activity, pregnancy or menopause, and the information should be tailored to their individualneeds. This information should also be given, as needed, to people who are closely involved with women and girls with epilepsy. These may include her family and/or carers. (Level III) NICE2012

All healthcare professionals who treat, care for, or support women and girls with epilepsy should be familiarwith relevant information and the availability of counseling. (Level III) NICE2012

Discuss with women and girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years), and their parents and/or carers if appropriate, the risk of AEDs causing malformations and possible neurodevelopmental impairments in an unborn child. Assess the risks and benefits of treatment with individual drugs. There are limited data on risks to the unborn child associated with newer drugs. Specifically discuss the risk of continued use of sodium valproate to the unborn child, being aware that higher doses of sodium valproate (more than 800 mg/day) and polytherapy, particularly with sodium valproate, are associated with greater risk. (Evidence comes from three systematic reviews; one review focused on incidence of malformation and the other two on child neurodevelopmental outcomes. No individual RCTs were reviewed. This recommendation was also based on GDG consensus opinion.) NICE 2012

In women of childbearing potential, the possibility of interaction with oral contraceptives should be discussed andan assessment made as to the risks and benefits of treatment with individual drugs. (Level III) NICE2012

In girls of childbearing potential, including young girls who are likely to need treatment into their childbearingyears, the possibility of interaction with oral contraceptives should be discussed with the child and/or her carer, and an assessment made as to the risks and benefits of treatment with individual drugs. (Level III) NICE2012

In women and girls of childbearing potential, the risks and benefits of different contraceptive methods, including hormone-releasing intrauterine devices (IUDs), should be discussed. (Level III) NICE 2012

If a woman or girl taking enzyme-inducing AEDs chooses to take the combined oral contraceptive pill, guidance about dosage should be sought from the SPC and current edition of the BNF (available at guidance about dosage should be sought from the SPC and current edition of the BNF External Web Site Policy). (Level III) NICE 2012

Women and girls with epilepsy need accurate information during pregnancy, and the possibility of status epilepticus and sudden death in epilepsy (SUDEP) should be discussed with all women and girls who plan to stop AED therapy (see the section 'Withdrawal of Pharmacologic Treatment' above). NICE2012

 

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