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Thursday, May 4, 2017

CPT code 80156, 80157 and 80184, 80185

Measure Name: Annual Monitoring of Anticonvulsant, Carbamazepine

Rule Description:

1) The percentage of patients 18 years and older who received at least 180 days of carbamazepine therapy and had at least one therapeutic monitoring event during the measurement year.

2) The percentage of patients 18 years and older who received at least 180 days of phenobarbital therapy and had at least one therapeutic monitoring event during the measurement year.

3) The percentage of patients 18 years and older who received at least 180 days of phenytoin therapy and had at least one therapeutic monitoring event during the measurement year.

4) The percentage of patients 18 years and older who received at least 180 days of valproic acid therapy and had at least one therapeutic monitoring event during the measurement year.

General Criteria Summary

1. Continuous enrollment: 1year
2. Anchor date: 31st  December of the measurement year
3. Gaps in enrollment: One 45-day gap allowed in each year of continuous enrollment
4. Medical coverage: Yes
5. Drug coverage: Yes
6. Attribution time frame: 1 year
7. Exclusions apply: Yes
8. Age range: 18 years and older



Note: Four separate denominator measures are being created because each subset used in a measure has to reference a specific rule.  It would be confusing to customers if we had measures that referred to rules that seemed unrelated. Therefore, there are separate subset and measure specifications for each Annual Monitoring denominator, even though the calculation of each denominator is exactly the same.

Denominator Description: All patients aged 18 years and older who received at least 180 treatment days of ambulatory anticonvulsant medication therapy during the measurement year

Inclusion Criteria: Patients aged 18 years and older as of the end of the measurement year who received at least 180 treatment days of ambulatory anticonvulsant medication therapy during the measurement year.  The four types of anticonvulsants checked are carbamazepine, phenobarbital, phenytoin, and valproic acid.



CPT  Description: Drug serum concentration for carbamazepine

80156 Carbamazepine; total
80157 Carbamazepine; free

LOINC
Description: Drug serum concentration for carbamazepine
3432-2 Drug serum concentration for carbamazepine
3433-0 Drug serum concentration for carbamazepine
9415-1 Drug serum concentration for carbamazepine
14056-6 Drug serum concentration for carbamazepine
14639-9 Drug serum concentration for carbamazepine
18270-9 Drug serum concentration for carbamazepine
29147-6 Drug serum concentration for carbamazepine
29148-4 Drug serum concentration for carbamazepine
32058-0 Drug serum concentration for carbamazepine
32852-6 Drug serum concentration for carbamazepine
47097-1 Drug serum concentration for carbamazepine

CPT Description: Drug serum concentration for phenobarbital
80184 Phenobarbital

LOINC Description: Drug serum concentration for phenobarbital
3948-7 Drug serum concentration for phenobarbital
3951-1 Drug serum concentration for phenobarbital
10547-8 Drug serum concentration for phenobarbital
14874-2 Drug serum concentration for phenobarbital
34365-7 Drug serum concentration for phenobarbital

CPT Description: Drug serum concentration for phenytoin
80185 Phenytoin; total
80186 Phenytoin; free

LOINC Description: Drug serum concentration for phenytoin
3968-5 Drug serum concentration for phenytoin
3969-3 Drug serum concentration for phenytoin
14877-5 Drug serum concentration for phenytoin
32109-1 Drug serum concentration for phenytoin

40460-8 Drug serum concentration for phenytoin

CPT Description: Drug serum concentration for valproic acid
80164 Dipropylacetic acid (valproic acid)


LOINC Description: Drug serum concentration for valproic acid
4086-5 Drug serum concentration for valproic acid
4087-3 Drug serum concentration for valproic acid
4088-1 Drug serum concentration for valproic acid
14946-8 Drug serum concentration for valproic acid
18489-5 Drug serum concentration for valproic acid
21590-5 Drug serum concentration for valproic acid
32119-0 Drug serum concentration for valproic acid
32283-4 Drug serum concentration for valproic acid

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