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2021 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.

NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

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, including all individuals of childbearing potential (12 years and older) with a diagnosis of epilepsy

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs

Definition:

Female Unable to Bear Children – For the purposes of this measure, this includes patients who are premenstrual, 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): 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241*, 99242*, 99243*, 99244*, 99245*

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 potentialwith epilepsy (4340F)

OR

Performance Not Met: Counseling about epilepsy specific safety issues provided to patient or caregiver was notperformed, reason not otherwise specified (4340F with8P)

 

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

AED=Antiepileptic Drugs; WWE= Women with Epilepsy; MCMs=major congenital malformations; VPA=valproate; PHT=phenytoin; LTG=lamotrigine; CBZ=carbamazepine; PHT=phenytoin; PB=phenobarbital]

• There is probably no substantially increased risk (greater than two times expected) of late pregnancy bleeding for WWE taking AEDs (Level B). Neurology 2009; 73(2): 126-132
• There is probably no moderately increased risk (greater than 1.5 times expected) of premature contractions or premature labor and delivery for WWE taking AEDs (Level B). Neurology 2009; 73(2): 126-132
• Seizure freedom for at least 9 months prior to pregnancy is probably associated with a high likelihood (84%–92%) of remaining seizure-free during pregnancy (Level B). Neurology 2009; 73(2): 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; 73(2): 133–141.
• If possible, avoidance of the use of VPA as part of polytherapy during the first trimester of pregnancy should be considered to decrease the risk of MCMs (Level B). Neurology; 73(2): 133–141.
• To reduce the risk of MCMs, the use of VPA during the first trimester of pregnancy should be avoided, if possible, compared to the use of CBZ (Level A). Neurology; 73(2): 133–141.
• To reduce the risk of MCMs, avoidance of the use of polytherapy with VPA during the first trimester of pregnancy, if possible, should be considered, compared to polytherapy without VPA (Level B). Neurology; 73(2): 133–141.
• Avoidance of the use of VPA, if possible, should be considered to reduce the risk of neural tube defects and facial clefts (Level B) and may be considered to reduce the risk of hypospadias (Level C). Neurology; 73(2): 133–141.
• CBZ exposure probably does not produce cognitive impairment in offspring of WWE (Level B). Neurology; 73(2): 133–141.
​​​​​​​• Avoiding VPA in WWE during pregnancy, if possible, should be considered to reduce the risk of poor cognitive outcomes (Level B). Neurology; 73(2): 133–141.
​​​​​​​• For WWE who are pregnant, avoidance of VPA, if possible, should be considered compared to CBZ to reduce the risk of poor cognitive outcomes (Level B). Neurology; 73(2): 133–141.
• The fact that PB, PRM, PHT, CBZ, LVT, VPA, GBP, LTG, OXC, and TPM cross the placenta may be factored into the clinical decision regarding the necessity of AED treatment for a woman with epilepsy (Level B for PB, PRM, PHT, CBZ, LVT, and VPA, and Level C for GBP, LTG, OXC, and TPM). Neurology 2009; 73(2): 142-149

 

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