MEASURE #10: PLAN OF CARE FOR MIGRAINE OR CERVICOGENIC HEADACHE DEVELOPED OR REVIEWED Headache Measure Descriptin All patients diagnsed with migraine headache r cervicgenic headache wh had a headache management plan f care develped r reviewed at least nce during the 12 mnth measurement perid. Measure Cmpnents Numeratr Statement Patients wh had a headache management plan f care fr migraine headache r cervicgenic headache* develped r reviewed by the clinician at least nce during the 12 mnth measurement perid. Statement Exceptins Supprting Guideline & Other References *Headache management plan f care may include: gals fr headache management (e.g., reduced number f days f migraine per mnth, reduce severity f headache), a plan fr acute migraine medicatins, preventive migraine medicatins, nn-pharmaclgical ptins (e.g., trigger management, stress reductin, physical therapy), cmmunicatin between prviders, referral t a headache specialist r ther relevant items. All patients diagnsed with migraine headache r cervicgenic headache. Exceptins: Medical exceptins fr nt develping r reviewing a plan f care fr migraine r cervicgenic headache (i.e., patient is cgnitively impaired, cannt cmmunicate and n caregiver is available) The fllwing clinical recmmendatin statements are quted verbatim frm the referenced clinical guidelines r evidence papers and represent the evidence base fr the measure: Develp a written headache treatment plan fr preventin and management f acute migraine t: Decrease headache frequency (aim fr fewer than 5 headache days per mnth). Decrease headache severity (headaches will respnd quickly t an abrtive therapy). Avid medicatin/caffeine veruse headache (see treatment: medicatin veruse headaches). Lifestyle mdificatins/nn-pharmaclgic ptins: Prvide selfmanagement educatin. Teach and encurage patients t maintain a healthy lifestyle (prper nutritin, regular physical activity, adequate sleep, and stress reductin strategies). Identify and avid triggers (e.g., tbacc smke, strng drs, r sprays). Address wrkplace ergnmics (attentin t wrkplace ergnmics and instructin in self-care f neck tensin can have a dramatic effect n headache frequency). Pharmaclgic ptins: The chice f acute migraine treatments shuld be dictated by the rapidity f nset, headache severity, assciated symptms (e.g., nausea/vmiting), and patient preference (N strength f evidence. gal). 1 Include the fllwing in discussins with the persn with a headache disrder: a psitive diagnsis, including an explanatin f the diagnsis and reassurance that 2014. American Academy f Neurlgy. All Rights Reserved. 69
ther pathlgy has been excluded and the ptins fr management and recgnitin that headache is a valid medical disrder that can have a significant impact n the persn and their family r caregivers. (N strength f evidence; age12 years ld and lder) 2 A cmprehensive therapy plan shuld encmpass the whle patient, via a patientphysician partnership where gals and strategies are mutually established. Key treatments include nndrug appraches, such as educatin and lifestyle mdificatins, t reduce the ccurrence f attacks, as well as acute medicatins t address the immediate need fr relief during an attack. 3 A cmprehensive migraine management plan invlves a partnership between the patient and healthcare prfessinal where treatment gals and strategies are established. Elements f such a plan shuld include preventive strategies t reduce the frequency and effects f future attacks as well as the use f acute treatments t address the immediate need fr relief during an attack. Appraches t preventin include educatin, lifestyle mdificatin, and, ften, apprpriate medicatin. 1 GrupHealth Migraine and Tensin Headache Diagnsis and Treatment Guideline 2011 https://www.ghc.rg/all-sites/guidelines/headache.pdf 2 NICE Headaches: Diagnsis and management f headaches in yung peple and adults. Natinal Clinical Guideline Centre n behalf f the Natinal Institute fr Health and Clinical Excellence (NICE) September 2012; NICE clinical guideline 150 3 Diamnd ML, Wenzel RG, Nissan GR. Optimizing migraine therapy: evidence-based and patient-centered care. Expert Rev Neurther. 2006 Jun;6(6):911-9. 4Diamnd M, Cady R. Initiating and ptimizing acute therapy fr migraine: the rle f patient-centered stratified care. Am J Med. 2005 Mar;118 Suppl 1:18S-27S Ratinale Optimizing headache management requires a systematic assessment f symptms, including the develpment f an individualized plan f care. Clinicians are advised t base their treatment chice n degree f disability alng with attack frequency and duratin, nnheadache symptms, patient preference, and prir histry f treatment respnse, using a stratified apprach t care. 1 This infrmatin shuld be included in the patient s plan f care. HRQL and disability are psitively impacted by treatment interventins and a cntinuity f care. 1 Gap in Care It is critical that patients have a successful plan f care fr migraine r cervicgenic headaches. This plan f care may include the use f acute and/r prphylactic medicatins, behavir management, patient preferences, histry f respnse t medicatin, and headache severity. Evidence als suggests that persn and scietal csts f headache disrders are likely t be reduced when headache patients receive apprpriate treatment and when a cntinuity f care is ffered. 2 Opprtunity fr Imprvement There is a ntewrthy need t imprve care crdinatin and patient engagement in the management f migraine and cervicgenic headaches thrugh the creatin and use f a headache care plan. Creating and implementing a plan f care can increase quality f life by reducing headache severity r duratin f headaches, decrease disability, imprve patient satisfactin with care, and decrease csts frm inapprpriate medicatins and/r diagnstic tests. 2014. American Academy f Neurlgy. All Rights Reserved. 70
1D Amic D, Grazzi L, Usai S, Lenardi M. Disability and quality f life in headache: where are we nt and where we are heading. Neurl Sci 2013; 34(S1):S1-S5 2Smith TR, Nichlsn RA, Banks JW. Migraine educatin imprves quality f life in primary care setting. Headache. 2010; 50: 600-612 Measure Designatin Measure purpse Type f measure Level f Measurement Care setting Data surce Quality imprvement Accuntability Prcess Ppulatin r System Level Outpatient visits Electrnic health recrd (EHR) data Administrative Data/Claims (inpatient r utpatient claims) Administrative Data/Claims Expanded (multiple-surce) Paper medical recrd Technical Specificatins: Administrative/Claims Data Administrative claims data cllectin requires users t identify the eligible ppulatin (denminatr) and numeratr using cdes recrded n claims r billing frms (electrnic r paper). Users reprt a rate based n all patients in a given practice fr whm data are available and wh meet the eligible denminatr criteria. The specificatins listed belw are thse needed fr perfrmance calculatin. (Eligible Ppulatin) ICD-9 and ICD-10 Diagnsis Cdes: ICD-9 346.0 Migraine with aura 346.00 346.01 346.02 346.03 346.1 Migraine withut aura 346.10 346.11 346.12 346.13 346.2 Variants f migraine 346.20 346.21 346.22 346.23 ICD-10 G43.109, Migraine with aura, nt intractable, withut G43.119, Migraine with aura, intractable, withut G43.101, Migraine with aura, nt intractable, with G43.111, Migraine with aura, intractable, with G43.009 Migraine withut aura, nt intractable, withut G43.019 Migraine withut aura, intractable, withut G43.001, Migraine withut aura, nt intractable, with G43.011, Migraine withut aura, intractable with G43.809, Other migraine, nt intractable withut G43.819 Other migraine, intractable, withut G43.801, Other migraine, nt intractable, with G43.811, Other migraine, intractable, 2014. American Academy f Neurlgy. All Rights Reserved. 71
346.4 Menstrual Migraine 346.40 346.41 346.42 346.43 346.5 Persistent Migraine 346.50 346.51 346.52 346.53 346.6 Persistent Migraine aura with cerebral infarctin 346.60 346.61 346.62 346.63 346.7 Chrnic migraine withut aura 346.70 346.71 346.72 346.73 346.8 Other frms f migraine 346.80 346.81 346.82 346.83 with G43.829 Menstrual migraine nt intractable, withut status migrainus G43.839 Menstrual migraine intractable withut G43.821 Menstrual migraine nt intractable with G43.831 Menstrual migraine intractable with G43.509 Persistent migraine aura withut cerebral infarctin, nt intractable, withut G43.519 Persistent migraine aura withut cerebral infarctin intractable withut G43.501 Persistent migraine aura withut cerebral infarctin nt intractable with G43.511 Persistent migraine aura withut cerebral infarctin intractable with G43.609 Persistent migraine aura with cerebral infarctin, nt intractable, withut G43.619 Persistent migraine aura with cerebral infarctin, intractable, withut G43.601 Persistent migraine aura with cerebral infarctin, nt intractable with G43.611 Persistent migraine aura with cerebral infarctin, intractable, with status migrainsus G43.709 Chrnic migraine withut aura, nt intractable, withut G43.719 Chrnic migraine withut aura, intractable, withut G43.701 Chrnic migraine withut aura, nt intractable, with G43.711 Chrnic migraine withut aura, intractable, with G43.809 Other migraine, nt intractable, withut G43.819 Other migraine intractable withut G43.801 Other migraine nt intractable with G43.811 Other migraine intractable with status migrainsus 2014. American Academy f Neurlgy. All Rights Reserved. 72
346.9 Migraine unspecified 346.90 346.91 346.92 346.93 G43.909 Migraine unspecified nt intractable withut G43.919 Migraine unspecified intractable withut G43.901 Migraine unspecified nt intractable with G43.911 Migraine unspecified intractable with AND CPT Evaluatin and Management Service Cdes: Outpatient: 99201-5, (Office r ther utpatient visit-new Patient); 99211-5 (Office r ther utpatient visit-established Patient); 99241-5 (Office r Other Outpatient Cnsultatin-New r Established Patient); 2014. American Academy f Neurlgy. All Rights Reserved. 73