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Metabolic Monitoring for Children and Adolescents on Antipsychotics

EHP, Priority Partners, and USFHP. Members 1-17 years of age.

The percentage of members 1-17 years of age who had two or more antipsychotic prescriptions and had metabolic testing.

Three rates are reported (#3 is Accreditation for Commercial and Medicaid):

  1. Percentage of children and adolescents on antipsychotics who received blood glucose testing.
  2. Percentage of children and adolescents on antipsychotics who received cholesterol testing.
  3. Percentage of children and adolescents on antipsychotics who received blood glucose and cholesterol testing.

Best Practice and Measure Tips

Members who received both of the following during the measurement year on the same or different dates of service:

  • At least one test for blood glucose or HbA1c and at least one test for LDL-C or cholesterol.
  • If the medications are dispensed on different dates, even if it’s the same medication, test both blood glucose with either a glucose or HbA1c test, and cholesterol with either a cholesterol or LDL-C test.
  • Measure baseline lipid profiles, fasting blood glucose level and body mass index.
  • Ordering a blood glucose and cholesterol test every year and building care gap alerts in the electronic medical record.
  • Testing blood glucose and cholesterol at a member’s annual checkup or school physical to reduce additional visits.
  • Educate members and caregivers about the:
    • Increased risk of metabolic health complications from antipsychotic medications.
    • Importance of screening blood glucose and cholesterol levels.
  • Behavioral health providers:
    • Ordering blood glucose and cholesterol screening tests for members who do not have regular contact with their PCP and within 1 month of changing a member’s medication.

Measure Exclusions

Required Exclusion: Hospice

Measure Codes

  • Need both an A1C or GLUCOSE and LDL C CODES.
  • HbA1C Lab Tests
    • CPT: 83036, 83037 CPT-CAT-II: 3044F, 3045F, 3046F
  • Glucose Lab Tests
    • CPT: 80047, 80048, 80050, 80053, 80069, 82947, 82950, 82951
  • LDL-C Lab Tests
    • CPT: 80061, 83700, 83701, 83704, 83721
    • CPT-CAT-II: 3048F, 3049F, 3050F

Measure Medications

  • Antipsychotic Medications
  • Miscellaneous antipsychotic agents
    • Aripiprazole
    • Asenapine
    • Brexpiprazole
    • Cariprazine
    • Clozapine
    • Haloperidol
    • Iloperidone
    • Loxapine
    • Lurasidone
    • Molindone
    • Olanzapine
    • Paliperidone
    • Pimozide
    • Quetiapine
    • Risperidone
    • Ziprasidone
  • Phenothiazine antipsychotics
    • Perphenazine
    • Thioridazine
    • Trifluoperazine Thioxanthenes
    • Thiothixene
  • Long-acting injections
    • Aripiprazole
    • Fluphenazine decanoate
    • Haloperidol decanoate
    • Olanzapine
    • Paliperidone palmitate
    • Risperidone
  • Antipsychotic Combination Medications
  • Psychotherapeutic combinations
    • Fluoxetine-olanzapine
    • Perphenazine-amitriptyline Prochlorperazine Medications
  • Phenothiazine antipsychotics
    • Prochlorperazine