Skip to main content
COVID-19

Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)

HEDIS Measure

Metabolic Monitoring for Children and Adolescents on Antipsychotics (APM)

Line of business: Commercial Medicaid

Data Collection Method: Administrative

Measure Description

The percentage of children and adolescents 1–17 years of age who had two or more antipsychotic prescriptions and had metabolic testing.

Three rates are reported:

  • The percentage of children and adolescents on antipsychotics who received blood glucose testing.
  • The percentage of children and adolescents on antipsychotics who received cholesterol testing.
  • The percentage of children and adolescents on antipsychotics who received blood glucose and cholesterol testing.

Numerator Compliance

Blood Glucose - Members who received at least one test for blood glucose during the measurement year.

Cholesterol - Members who received at least one test for LDL-C during the measurement year.

Blood Glucose and Cholesterol - Members who received both of the following during the measurement year on the same or different dates of service.

Best Practices

  • Monitor glucose and cholesterol levels for children and adolescents on antipsychotic medications as The American Academy of Child and Adolescent Psychiatry (AACCAP) recommends metabolic monitoring
  • Monitor children on antipsychotic medications to avoid metabolic health complications such as weight gain and diabetes
  • Inform parents/guardians of metabolic problems in childhood and adolescence that are associated with poor cardio-metabolic outcomes in adulthood
  • Inform parents/guardians of the long-term consequences of pediatric obesity and other metabolic disturbances including higher risk of heart disease in adulthood
  • Establish a baseline and continuously monitor metabolic indices to ensure appropriate management of side-effects of antipsychotic medication therapy
  • Arrange for lab tests to be done in the office during a patient’s visit or schedule lab testing before the patient and parent/guardian leaves the office
  • Determine whether the electronic medical record can flag for lab tests based on diagnosis or when antipsychotic medications are prescribed
  • Educate the parent/guardian about appropriate health screenings for certain medication therapies
  • Coordinate care between Primary Care Physicians (PCP) and Behavioral Health specialists
  • Monitor glucose and cholesterol levels for children and adolescents on antipsychotic medications as The American Academy of Child and Adolescent Psychiatry (AACCAP) recommends metabolic monitoring

Quality Value Set Directory Coding Tips

Glucose Lab Test

ICD10CM

  • L89.000
  • L89.001
  • L89.002
  • L89.003
  • L89.004
  • L89.006
  • L89.009
  • L89.010
  • L89.011
  • L89.012
  • L89.013
  • L89.014
  • L89.016
  • L89.019
  • L89.020
  • L89.021
  • L89.022
  • L89.023
  • L89.024
  • L89.026
  • L89.029
  • L89.100
  • L89.101
  • L89.102
  • L89.103
  • L89.104
  • L89.106
  • L89.109
  • L89.110
  • L89.111
  • L89.112
  • L89.113
  • L89.114
  • L89.116
  • L89.119
  • L89.120
  • L89.121
  • L89.122
  • L89.123
  • L89.124
  • L89.126
  • L89.129
  • L89.130
  • L89.131
  • L89.132
  • L89.133
  • L89.134
  • L89.136
  • L89.139
  • L89.140
  • L89.141
  • L89.142
  • L89.143
  • L89.144
  • L89.146
  • L89.149
  • L89.150
  • L89.151
  • L89.152
  • L89.153
  • L89.154
  • L89.156
  • L89.159
  • L89.200
  • L89.201
  • L89.202
  • L89.203
  • L89.204
  • L89.206
  • L89.209
  • L89.210
  • L89.211
  • L89.212
  • L89.213
  • L89.214
  • L89.216
  • L89.219
  • L89.220
  • L89.221
  • L89.222
  • L89.223
  • L89.224
  • L89.226
  • L89.229
  • L89.300
  • L89.301
  • L89.302
  • L89.303
  • L89.304
  • L89.306
  • L89.309
  • L89.310
  • L89.311
  • L89.312
  • L89.313
  • L89.314
  • L89.316
  • L89.319
  • L89.320
  • L89.321
  • L89.322
  • L89.323
  • L89.324
  • L89.326
  • L89.329
  • L89.40
  • L89.41
  • L89.42
  • L89.43
  • L89.44
  • L89.45
  • L89.46
  • L89.500
  • L89.501
  • L89.502
  • L89.503
  • L89.504
  • L89.506
  • L89.509
  • L89.510
  • L89.511
  • L89.512
  • L89.513
  • L89.514
  • L89.516
  • L89.519
  • L89.520
  • L89.521
  • L89.522
  • L89.523
  • L89.524
  • L89.526
  • L89.529
  • L89.600
  • L89.601
  • L89.602
  • L89.603
  • L89.604
  • L89.606
  • L89.609
  • L89.610
  • L89.611
  • L89.612
  • L89.613
  • L89.614
  • L89.616
  • L89.619
  • L89.620
  • L89.621
  • L89.622
  • L89.623
  • L89.624
  • L89.626
  • L89.629
  • L89.810
  • L89.811
  • L89.812
  • L89.813
  • L89.814
  • L89.816
  • L89.819
  • L89.890
  • L89.891
  • L89.892
  • L89.893
  • L89.894
  • L89.896
  • L89.899
  • L89.90
  • L89.91
  • L89.92
  • L89.93
  • L89.94
  • L89.95
  • L89.96
  • M62.50
  • M62.81
  • M62.84
  • W01.0XXA
  • W01.0XXD
  • W01.0XXS
  • W01.10XA
  • W01.10XD
  • W01.10XS
  • W01.110A
  • W01.110D
  • W01.110S
  • W01.111A
  • W01.111D
  • W01.111S
  • W01.118A
  • W01.118D
  • W01.118S
  • W01.119A
  • W01.119D
  • W01.119S
  • W01.190A
  • W01.190D
  • W01.190S
  • W01.198A
  • W01.198D
  • W01.198S
  • W06.XXXA
  • W06.XXXD
  • W06.XXXS
  • W07.XXXA
  • W07.XXXD
  • W07.XXXS
  • W08.XXXA
  • W08.XXXD
  • W08.XXXS
  • W10.0XXA
  • W10.0XXD
  • W10.0XXS
  • W10.1XXA
  • W10.1XXD
  • W10.1XXS
  • W10.2XXA
  • W10.2XXD
  • W10.2XXS
  • W10.8XXA
  • W10.8XXD
  • W10.8XXS
  • W10.9XXA
  • W10.9XXD
  • W10.9XXS
  • W18.00XA
  • W18.00XD
  • W18.00XS
  • W18.02XA
  • W18.02XD
  • W18.02XS
  • W18.09XA
  • W18.09XD
  • W18.09XS
  • W18.11XA
  • W18.11XD
  • W18.11XS
  • W18.12XA
  • W18.12XD
  • W18.12XS
  • W18.2XXA
  • W18.2XXD
  • W18.2XXS
  • W18.30XA
  • W18.30XD
  • W18.30XS
  • W18.31XA
  • W18.31XD
  • W18.31XS
  • W18.39XA
  • W18.39XD
  • W18.39XS
  • W19.XXXA
  • W19.XXXD
  • W19.XXXS
  • Y92.199
  • Z59.3
  • Z73.6
  • Z74.01
  • Z74.09
  • Z74.1
  • Z74.2
  • Z74.3
  • Z74.8
  • Z74.9
  • Z91.81
  • Z99.11
  • Z99.3
  • Z99.81
  • Z99.89
  • SNOMED CT US Edition

    • 16728003
    • 17886000
    • 20902002
    • 33036003
    • 40104005
    • 44188002
    • 52702003
    • 56307009
    • 67223001
    • 74541001
    • 83468000
    • 90619006
    • 129588001
    • 162845004
    • 214436006
    • 214437002
    • 214438007
    • 214439004
    • 214441003
    • 214442005
    • 214443000
    • 214444006
    • 217082002
    • 217083007
    • 217084001
    • 217086004
    • 217088003
    • 217090002
    • 217092005
    • 217093000
    • 217094006
    • 217142006
    • 217154006
    • 217155007
    • 217156008
    • 217157004
    • 217158009
    • 217173005
    • 225558004
    • 225562005
    • 225563000
    • 242109009
    • 242389003
    • 242390007
    • 242391006
    • 242392004
    • 242395002
    • 242396001
    • 242413007
    • 242414001
    • 242419006
    • 269699007
    • 274918000
    • 414188008
    • 414189000
    • 414190009
    • 427849003
    • 428484005
    • 429621003
    • 699214007
    • 699215008
    • 699216009
    • 699218005
    • 715504003
    • 763829004
    • 823018004
    • 92341000119107
    • 138371000119104
    • 8960001000004106
    • 10637031000119106
    • 10637071000119109
    • 10637111000119102
    • 10637151000119101
  • Glucose Test Result or Finding

    CPT

    • 99504
    • 99509

    HCPCS

    • G0162
    • G0299
    • G0300
    • G0493
    • G0494
    • S0271
    • S0311
    • S9123
    • S9124
    • T1000
    • T1001
    • T1002
    • T1003
    • T1004
    • T1005
    • T1019
    • T1020
    • T1021
    • T1022
    • T1030
    • T1031

    HbA1c Lab Test

    ICD10CM

    • R26.0
    • R26.1
    • R26.2
    • R26.89
    • R26.9
    • R41.81
    • R53.1
    • R53.81
    • R53.83
    • R54
    • R62.7
    • R63.4
    • R63.6
    • R64

    SNOMED CT US Edition

    • 4468000
    • 8510008
    • 13791008
    • 18726006
    • 20940004
    • 22090007
    • 22325002
    • 22631008
    • 23042008
    • 25136009
    • 26544005
    • 41786007
    • 43005009
    • 50314001
    • 67141003
    • 78119002
    • 78691002
    • 84229001
    • 89362005
    • 102492002
    • 102568007
    • 102891000
    • 105501005
    • 105503008
    • 105504002
    • 126013009
    • 127378008
    • 135834002
    • 160681005
    • 160683008
    • 160684002
    • 160685001
    • 160692006
    • 160693001
    • 160734000
    • 160737007
    • 161832001
    • 161873000
    • 161874006
    • 162236007
    • 162239000
    • 163600007
    • 163686004
    • 163695007
    • 165243005
    • 165244004
    • 224960004
    • 225612007
    • 238108007
    • 248269005
    • 248278004
    • 248279007
    • 249888000
    • 249937002
    • 249938007
    • 249939004
    • 249940002
    • 249941003
    • 249942005
    • 249943000
    • 249946008
    • 250002000
    • 250003005
    • 250015009
    • 250029005
    • 250032008
    • 250033003
    • 250034009
    • 250038007
    • 250043000
    • 250044006
    • 250045007
    • 250048009
    • 250052009
    • 250054005
    • 262285001
    • 267024001
    • 267031002
    • 267032009
    • 268964003
    • 271795006
    • 271875007
    • 272036004
    • 272060000
    • 272062008
    • 275313006
    • 284529003
    • 298283006
    • 300948004
    • 309249007
    • 309257005
    • 312444006
    • 314109004
    • 365884000
    • 367391008
    • 371028005
    • 373931001
    • 394616008
    • 397776000
    • 404904002
    • 413121008
    • 418073009
    • 422868009
    • 426977000
    • 428116008
    • 428264009
    • 429091008
    • 429487005
    • 431524008
    • 432559006
    • 442099003
    • 444042007
    • 444932008
    • 448765001
    • 713512009
    • 713514005
    • 713568000
    • 713655003
    • 784317004
    • 784318009
    • 788876001
    • 788900007
    • 931000119107
    • 60631000119109
    • 60651000119103
    • 69161000119103
    • 79021000119104
    • 79031000119101
    • 85711000119103
    • 89201000119106
    • 152921000119101
    • 250991000119100
    • 15634971000119107
    • 16018391000119104
    • 16018431000119109
    • 16419651000119103

    HbA1c Test Result or Finding

    HCPCS

    • G9473
    • G9474
    • G9475
    • G9476
    • G9477
    • G9478
    • G9479
    • Q5003
    • Q5004
    • Q5005
    • Q5006
    • Q5007
    • Q5008
    • Q5010
    • S9126
    • T2042
    • T2043
    • T2044
    • T2045
    • T2046

    SNOMED CT US Edition

    • 183919006
    • 183920000
    • 183921001
    • 305336008
    • 305911006
    • 385765002

    UBREV

    • 0115
    • 0125
    • 0135
    • 0145
    • 0155
    • 0235
    • 0650
    • 0651
    • 0652
    • 0655
    • 0656
    • 0657
    • 0658
    • 0659

    LDL-C Lab Test

    CPT

    • 99377
    • 99378

    HCPCS

    • G0182

    SNOMED CT US Edition

    • 170935008
    • 170936009
    • 385763009

    LDL-C Test Result or Finding

    UBREV

    • 0100
    • 0101
    • 0110
    • 0111
    • 0112
    • 0113
    • 0114
    • 0116
    • 0117
    • 0118
    • 0119
    • 0120
    • 0121
    • 0122
    • 0123
    • 0124
    • 0126
    • 0127
    • 0128
    • 0129
    • 0130
    • 0131
    • 0132
    • 0133
    • 0134
    • 0136
    • 0137
    • 0138
    • 0139
    • 0140
    • 0141
    • 0142
    • 0143
    • 0144
    • 0146
    • 0147
    • 0148
    • 0149
    • 0150
    • 0151
    • 0152
    • 0153
    • 0154
    • 0156
    • 0157
    • 0158
    • 0159
    • 0160
    • 0164
    • 0167
    • 0169
    • 0170
    • 0171
    • 0172
    • 0173
    • 0174
    • 0179
    • 0190
    • 0191
    • 0192
    • 0193
    • 0194
    • 0199
    • 0200
    • 0201
    • 0202
    • 0203
    • 0204
    • 0206
    • 0207
    • 0208
    • 0209
    • 0210
    • 0211
    • 0212
    • 0213
    • 0214
    • 0219
    • 1000
    • 1001
    • 1002

    Cholesterol Lab Test

    HCPCS

    • J2794

    Cholesterol Test Result or Finding

    HCPCS

    • J0401
    • J1631
    • J1943
    • J1944
    • J2358
    • J2426
    • J2680