The HEDIS measure Follow-Up Care for Children Prescribed ADHD Medication (ADD) is the percentage of children newly prescribed attention-deficit/hyperactivity disorder (ADHD) medication who had at least three follow-up care visits within a 10-month period, one of which was within 30 days of when the first ADHD medication was dispensed. The measure looks at two rates – the initiation phase and the continuation/maintenance phase. Details about each phase, as well as tips for success, are listed below.
Initiation phase: The percentage of children ages 6-12 years as of the index prescription date (IPSD) with an ambulatory prescription dispensed for ADHD medication, who had one follow-up visit with a practitioner with prescribing authority in the first 30 days of the Rx dispensation.
Continuation & maintenance phase: The percentage of children ages 6-12 years as of the index prescription date (IPSD) with an ambulatory prescription dispensed for ADHD medication, who remained on the medication for at least 210 days and who, in addition to the visit in the initiation phase, had at least two follow-up visits with a practitioner within 270 days (nine months) after the initiation phase ended.
Schedule two more visits in the nine months after the first 30 days to continue to monitor your patient’s progress.
Telephone codes can be used to help satisfy the requirements for the continuation & maintenance phase part of the measure. The following codes are covered, but not separately reimbursed, by BCBSRI: 98966, 98967, 98968, 99441, 99442, and 99443. You may use these codes to satisfy the numerator for the continuation measure if you do not see your patient face to face, but rather complete a follow-up call.
Keep in mind that controlled substances should not be reordered without at least two visits per year to evaluate a child’s progress and growth.