CMS 156 - Use of High-Risk Medications in the Elderly

Medical Codify

CMS156v5 (2017)

CMS156v6 (2018)

CMS156v7 (2019)

Description:  Percentage of patients 65 years of age and older who were ordered high-risk medications. Two rates are reported.

  • Percentage of patients who were ordered at least one high-risk medication.
  • Percentage of patients who were ordered at least two of the same high-risk medications.

Initial Patient Population:  Patients 65 years and older who had a visit during the measurement period.

Denominator:  Equals Initial Population

Numerator

Numerator 1: Patients with an order for at least one high-risk medication during the measurement period

Numerator 2: Patients with at least two orders for the same high-risk medication during the measurement period

Inverse Measure:  Yes

Clinical Instructions

Note
This is an inverse measure. The goal is to have a 0 in the numerator.  When e-prescribing, avoid prescribing any of the medications listed below, to the specified population, whenever possible.

Track all patients that are 65+ and prescribed high-risk medications. Two rates are reported, so be aware that patients with at least one high-risk medication, as well as patients with at least two orders for the same high-risk medication, will be reported for the measurement period.

  • While documenting the encounter, use the Presenting Medications section and Medication Orders section to prescribe and reconcile medications, as usual.
  • Prescribe medications, as needed.
  • Continue documenting the encounter, as appropriate.
  • When complete, Close and Archive the encounter.

Evidence

Initial Patient Population

Name Value Set
Encounter, Performed: Annual Wellness Visit 2.16.840.1.113883.3.526.3.1240
Encounter, Performed: Home Healthcare Services 2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed: Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1025
Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1023
Encounter, Performed: Care Services in Long-Term Residential Facility 2.16.840.1.113883.3.464.1003.101.12.1014
Encounter, Performed: Discharge Services - Nursing Facility 2.16.840.1.113883.3.464.1003.101.12.1013
Encounter, Performed: Encounter Inpatient 2.16.840.1.113883.3.666.5.307
Encounter, Performed: Nursing Facility Visit 2.16.840.1.113883.3.464.1003.101.12.1012
Encounter, Performed: Ophthalmologic Outpatient Visit 2.16.840.1.113883.3.464.1003.101.11.1206

Denominator

Equals Initial Population

Numerator

Name Value Set
Acetaminophen / Butalbital / Caffeine / Codeine 2.16.840.1.113883.3.464.1003.196.12.1326
Acetaminophen / Butalbital / Caffeine 2.16.840.1.113883.3.464.1003.196.12.1363
Acetaminophen / Butalbital 2.16.840.1.113883.3.464.1003.196.12.1317
Acetaminophen / Chlorpheniramine / Dextromethorphan / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1310
Acetaminophen / Chlorpheniramine / Dextromethorphan / Pseudoephedrine 2.16.840.1.113883.3.464.1003.196.12.1321
Acetaminophen / Chlorpheniramine / Dextromethorphan 2.16.840.1.113883.3.464.1003.196.12.1421
Acetaminophen / Chlorpheniramine / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1328
Acetaminophen / Chlorpheniramine / Pseudoephedrine 2.16.840.1.113883.3.464.1003.196.12.1316
Acetaminophen / Dexbrompheniramine 2.16.840.1.113883.3.464.1003.196.12.1405
Acetaminophen / Dextromethorphan / Diphenhydramine / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1399
Acetaminophen / Dextromethorphan / Doxylamine / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1287
Acetaminophen / Dextromethorphan / Doxylamine 2.16.840.1.113883.3.464.1003.196.12.1338
Acetaminophen / Diphenhydramine / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1318
Acetaminophen / Diphenhydramine 2.16.840.1.113883.3.464.1003.196.12.1350
Amitriptyline / Chlordiazepoxide 2.16.840.1.113883.3.464.1003.196.12.1286
Amitriptyline / Perphenazine 2.16.840.1.113883.3.464.1003.196.12.1428
Amitriptyline Hydrochloride 2.16.840.1.113883.3.464.1003.196.12.1373
Amoxapine 2.16.840.1.113883.3.464.1003.196.12.1273
Anti Infectives, other 2.16.840.1.113883.3.464.1003.196.12.1481
Aspirin / Butalbital / Caffeine 2.16.840.1.113883.3.464.1003.196.12.1347
Aspirin / Caffeine / Orphenadrine 2.16.840.1.113883.3.464.1003.196.12.1302
Atropine / Diphenoxylate 2.16.840.1.113883.3.464.1003.196.12.1274
Atropine / Hyoscyamine / Phenobarbital / Scopolamine 2.16.840.1.113883.3.464.1003.196.12.1355
Benztropine 2.16.840.1.113883.3.464.1003.196.12.1361
Brompheniramine / Codeine / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1409
Brompheniramine / Codeine / Pseudoephedrine 2.16.840.1.113883.3.464.1003.196.12.1450
Brompheniramine / Dextromethorphan / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1325
Brompheniramine / Dextromethorphan / Pseudoephedrine 2.16.840.1.113883.3.464.1003.196.12.1339
Brompheniramine / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1327
Brompheniramine / Pseudoephedrine 2.16.840.1.113883.3.464.1003.196.12.1332
Brompheniramine 2.16.840.1.113883.3.464.1003.196.12.1427
Butabarbital 2.16.840.1.113883.3.464.1003.196.12.1402
Carbinoxamine 2.16.840.1.113883.3.464.1003.196.12.1306
Carisoprodol 2.16.840.1.113883.3.464.1003.196.12.1369
Chlophedianol / Chlorpheniramine / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1412
Chlophedianol / Dexchlorpheniramine / Pseudoephedrine 2.16.840.1.113883.3.464.1003.196.12.1447
Chlorpheniramine / Codeine 2.16.840.1.113883.3.464.1003.196.12.1301
Chlorpheniramine / Dextromethorphan / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1312
Chlorpheniramine / Dextromethorphan / Pseudoephedrine 2.16.840.1.113883.3.464.1003.196.12.1337
Chlorpheniramine / Hydrocodone / Pseudoephedrine 2.16.840.1.113883.3.464.1003.196.12.1299
Chlorpheniramine / Hydrocodone 2.16.840.1.113883.3.464.1003.196.12.1330
Chlorpheniramine / Phenylephrine / Phenyltoloxamine 2.16.840.1.113883.3.464.1003.196.12.1453
Chlorpheniramine / Phenylephrine / Pyrilamine 2.16.840.1.113883.3.464.1003.196.12.1309
Chlorpheniramine / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1343
Chlorpheniramine / Pseudoephedrine 2.16.840.1.113883.3.464.1003.196.12.1315
Chlorpheniramine 2.16.840.1.113883.3.464.1003.196.12.1352
Chlorpropamide 2.16.840.1.113883.3.464.1003.196.12.1303
Chlorzoxazone 2.16.840.1.113883.3.464.1003.196.12.1362
Clemastine 2.16.840.1.113883.3.464.1003.196.12.1308
Clomipramine 2.16.840.1.113883.3.464.1003.196.12.1336
Conjugated Estrogens / Medroxyprogesterone 2.16.840.1.113883.3.464.1003.196.12.1324
Conjugated Estrogens 2.16.840.1.113883.3.464.1003.196.12.1357
Cyclobenzaprine Hydrochloride 2.16.840.1.113883.3.464.1003.196.12.1372
Cyproheptadine 2.16.840.1.113883.3.464.1003.196.12.1277
Desiccated Thyroid 2.16.840.1.113883.3.464.1003.196.12.1354
Desipramine 2.16.840.1.113883.3.464.1003.196.12.1278
Dexbrompheniramine / Dextromethorphan / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1426
Dexbrompheniramine / Pseudoephedrine 2.16.840.1.113883.3.464.1003.196.12.1430
Dexbrompheniramine Maleate / Pseudoephedrine Hydrochloride 2.16.840.1.113883.3.464.1003.196.12.1429
Dexbrompheniramine 2.16.840.1.113883.3.464.1003.196.12.1375
Dexchlorpheniramine / Dextromethorphan / Pseudoephedrine 2.16.840.1.113883.3.464.1003.196.12.1300
Dexchlorpheniramine / Pseudoephedrine 2.16.840.1.113883.3.464.1003.196.12.1425
Dextromethorphan / Diphenhydramine / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1397
Dextromethorphan / Doxylamine 2.16.840.1.113883.3.464.1003.196.12.1452
Dicyclomine 2.16.840.1.113883.3.464.1003.196.12.1279
Dienogest / Estradiol Multiphasic 2.16.840.1.113883.3.464.1003.196.12.1398
Dimenhydrinate 2.16.840.1.113883.3.464.1003.196.12.1500
Diphenhydramine / Ibuprofen 2.16.840.1.113883.3.464.1003.196.12.1293
Diphenhydramine / Phenylephrine 2.16.840.1.113883.3.464.1003.196.12.1307
Diphenhydramine Hydrochloride 2.16.840.1.113883.3.464.1003.196.12.1371
Dipyridamole 2.16.840.1.113883.3.464.1003.196.12.1349
Disopyramide 2.16.840.1.113883.3.464.1003.196.12.1311
Drospirenone / Estradiol 2.16.840.1.113883.3.464.1003.196.12.1410
Esterified Estrogens / Methyltestosterone 2.16.840.1.113883.3.464.1003.196.12.1320
Esterified Estrogens 2.16.840.1.113883.3.464.1003.196.12.1419
Estradiol / Norethindrone 2.16.840.1.113883.3.464.1003.196.12.1323
Estradiol 2.16.840.1.113883.3.464.1003.196.12.1365
Estropipate 2.16.840.1.113883.3.464.1003.196.12.1319
Glyburide / Metformin 2.16.840.1.113883.3.464.1003.196.12.1360
Glyburide 2.16.840.1.113883.3.464.1003.196.12.1368
Guanfacine 2.16.840.1.113883.3.464.1003.196.12.1341
High Risk Medications for the Elderly 2.16.840.1.113883.3.464.1003.196.12.1253
High-Risk Medications With Days Supply Criteria 2.16.840.1.113883.3.464.1003.196.12.1254
Hydrochlorothiazide / Methyldopa 2.16.840.1.113883.3.464.1003.196.12.1414
Hydroxyzine 2.16.840.1.113883.3.464.1003.196.12.1374
Hyoscyamine / Methenamine / Mblue / Phenyl Salicyl / Sodium Biphosphate 2.16.840.1.113883.3.464.1003.196.12.1504
Hyoscyamine / Methenamine / Mblue / Phenyl Salicyl 2.16.840.1.113883.3.464.1003.196.12.1503
Hyoscyamine / Methenamine / Mblue / Sodium Biphosphate 2.16.840.1.113883.3.464.1003.196.12.1505
Hyoscyamine 2.16.840.1.113883.3.464.1003.196.12.1501
Imipramine 2.16.840.1.113883.3.464.1003.196.12.1359
Indomethacin 2.16.840.1.113883.3.464.1003.196.12.1366
Isoxsuprine 2.16.840.1.113883.3.464.1003.196.12.1422
Ketorolac Tromethamine 2.16.840.1.113883.3.464.1003.196.12.1364
List of Single RxNorm Code Concepts for High Risk Drugs for the Elderly 2.16.840.1.113883.3.464.1003.196.12.1272
Meclizine 2.16.840.1.113883.3.464.1003.196.12.1506
Megestrol 2.16.840.1.113883.3.464.1003.196.12.1342
Meperidine 2.16.840.1.113883.3.464.1003.196.12.1351
Meprobamate 2.16.840.1.113883.3.464.1003.196.12.1284
Metaxalone 2.16.840.1.113883.3.464.1003.196.12.1358
Methocarbamol 2.16.840.1.113883.3.464.1003.196.12.1370
Methyldopa 2.16.840.1.113883.3.464.1003.196.12.1331
Nifedipine 2.16.840.1.113883.3.464.1003.196.12.1353
Nonbenzodiazepine hypnotics 2.16.840.1.113883.3.464.1003.196.12.1480
Nortriptyline 2.16.840.1.113883.3.464.1003.196.12.1507
Paroxetine 2.16.840.1.113883.3.464.1003.196.12.1508
Phenobarbital 2.16.840.1.113883.3.464.1003.196.12.1348
Promethazine Hydrochloride 2.16.840.1.113883.3.464.1003.196.12.1367
Protriptyline 2.16.840.1.113883.3.464.1003.196.12.1509
Pseudoephedrine / Triprolidine 2.16.840.1.113883.3.464.1003.196.12.1345
Trihexyphenidyl 2.16.840.1.113883.3.464.1003.196.12.1334
Trimipramine 2.16.840.1.113883.3.464.1003.196.12.1285
Triprolidine 2.16.840.1.113883.3.464.1003.196.12.1408

Denominator Exclusion

Name Value Set
Intervention, Order: Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15
Intervention, Performed: Hospice care ambulatory 2.16.840.1.113762.1.4.1108.15

Source(s)

Medical Codify

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