Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients

Last updated: March 22, 2017

CMS Measure ID: CMS188v5
Version: 5
NQF Number: 0147
Measure Description:

(PN-6) Immunocompetent patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines

Population 1 Immunocompetent ICU patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines

Population 2 Immunocompetent non-Intensive Care Unit (ICU) patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines

Initial Patient Population:

Pneumonia patients 18 years of age and older at the time of admission to acute inpatient care with a discharge principal diagnosis of pneumonia, OR Principal Diagnosis of septicemia or respiratory failure (acute or chronic) AND also a secondary other diagnosis code of pneumonia. Patient with a LOS <=120 days and discharged during the measurement period.

This measure is divided into patients admitted to the intensive care unit (ICU population 1), and those admitted to non-ICU hospital locations (population 2).

For both populations, arrival at the hospital means either arrival at the ED or arrival as a direct admit to the inpatient setting.

Denominator Statement:

ICU population:
Patients who meet the Initial Population and:

  • Arrival at hospital is either arrival in ED or arrival to floor as direct admit
  • Admitted to ICU within 24 hours after arrival at hospital with reasons for admission due to pneumonia
  • Pneumonia related reasons for admission to ICU include:
    • Septic shock
    • Respiratory distress or failure
    • Hypotension
    • Tachypnea
    • Hypoxemia
    • Need for a ventilator
    • Tachycardia
  • Diagnosis of pneumonia documented within 24 hours after arrival; if seen in ED diagnosis must be documented in ED
  • Antibiotics received within 24 hours of arrival or within 1 day prior to hospital arrival and during hospital stay.

Non-ICU population:
Patients who meet the Initial Population and:

  • Arrival at hospital is either arrival in ED or arrival to floor as direct admit
  • Diagnosis of pneumonia documented within 24 hours after arrival; if seen in ED diagnosis must be documented in ED
  • Antibiotics received within 24 hours after arrival
Denominator Exclusions:

ICU Population only:

  • Patients transferred/admitted to the ICU within 24 hours after arrival to this hospital, with a beta-lactam allergy (population 1 only).

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For patients in both ICU and non-ICU the rest of the denominator exclusions are the same:

  • Patients with either a normal Chest X-ray or a normal CT scan which includes the chest within 1 day prior to arrival at the hospital or during the hospitalization
  • Patients who have “Comfort Measures” documented as performed or ordered on the day of or the day after arrival at the hospital or after arrival in the ED
  • Patients who are transferred from one of the following within 24 hours before the start of the ED encounter or the hospital encounter:
    • An acute care hospital
    • An ambulatory surgical center
    • A transfer from an emergency department of an outside hospital
    • A transfer from an outpatient department of an outside hospital
  • Patients who were an inpatient less than or equal to 1 day.

The following exclusions are “reasons for alternative empiric antibiotic therapy”:

  • Patients who have a diagnosis of a “prolonged QT interval” documented within 24 hours after arrival at the ED or the hospital
  • Patients who have an active diagnosis of an immunocompromised condition within the last 3 months before arrival at the ED or arrival at the hospital or during the hospitalization
  • Patients who have significant neutropenia, which is defined as a Neutrophil count of <500 per mm3 within the last 3 months before arrival at the ED or arrival at the hospital or during the hospitalization
  • Patients who have any of the following within 30 days before arrival at the ED or arrival at the hospital:
    • Hemodialysis or peritoneal dialysis
    • Wound care
    • Tracheostomy care
    • Ventilator care
    • Diagnosis of healthcare associated pneumonia
  • >
  • Patients who have any of the following which starts before the end of the inpatient hospitalization:
    • Immunodeficient conditions
    • Cystic Fibrosis
    • History of an organ transplant
  • Patients who have any of the following within 90 days before the start of either the ED or the direct admit:
    • Immunocompromised Therapies (radiation treatments, for instance)
    • Systemic Immunosuppressive therapy (chemotherapy, for instance)
    • A patient in a nursing home or an extended care facility
    • A patient in another acute care hospital
Numerator Statement:

Pneumonia patients who received an initial antibiotic regimen consistent with current guidelines during the first 24 hours of their hospitalization.

Numerator 1 (in population 1) defines appropriate antibiotics for ICU patients.

Numerator 2 (in population 2) defines appropriate antibiotics for non-ICU patients.

Non-ICU patients are evaluated for pseudomonal risk.

Pseudomonal risk requires certain antibiotics per clinical guidelines.

Pseudomonal risk includes:

  • Bronchiectasis
  • Structural lung disease which includes the following:
    • “Diagnosis, Active: COPD”
    • “Diagnosis, Active: Chronic bronchitis”
    • “Diagnosis, Active: Emphysema”
    • “Diagnosis, Active: Interstitial lung disease”
    • “Diagnosis, Active: Restrictive lung disease”
    • “Diagnosis, Active: Structural lung disease”
Numerator Exclusions:

Not Applicable

Denominator Exceptions:

Pneumonia patients with Another Source of Infection who did not receive an antibiotic regimen recommended for pneumonia, but did receive antibiotics within the first 24 hours of hospitalization. Pneumonia patients who have been on systemic corticosteroid/prednisone therapy within the last 90 days prior to arrival to the hospital.

Measure Steward: Centers for Medicare & Medicaid Services
Domain: Efficiency and Cost Reduction Use of Healthcare Resources
Short Name: PN6
Next Version: Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients
Previous Version: Initial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent Patients
Measure Score: Proportion
Improvement Notation:

Improvement noted as an increase in rate

Guidance:

General guidance:

The measure criteria indicate scenarios in which the patient is admitted to the hospital directly (to ICU or Non-ICU locations) or the patient is admitted to one of these locations from the Emergency Department (ED).

The calculation is to indicate the timing from arrival at the facility to the occurrence of an event. The arrival, therefore can be determined from the Emergency Department, the Non-ICU location, or the ICU location, whichever is the first location of contact between the patient and the facility.

Exclusion element guidance:

Transfers from another hospital that is not part of the hospital's organization are excluded since care may have been delivered in the other setting. The measure as specified for abstraction allowed determination of other hospitals by hospital billing number.

Transfers within 1 day from those hospitals using the same facility number are not considered transfers for the exclusion section of this measure, those using other facility numbers are considered exclusions.

Respiratory Infection exclusion- the logic indicates that the patient is included if they have a respiratory infection but excluded for any other infection unless the encounter ends <=24 hr after the start.

The exclusion for absolute neutrophil count < 500 may require calculation. The absolute neutrophil count (ANC) = Total WBC x (% Segs + % Bands), OR WBC x ((Segs/100) + (Bands/100)).

Specifications

Release Notes

Header

  • Added to the header metadata to give more detailed descriptions for the Initial Population, the Denominator, the Denominator Exclusions, the Numerator and the Denominator Exceptions which now matches more closely the logic in the eCQM. A Measure Item Count was added, in this measure it is 'Encounter, performed: Encounter Inpatient'.
  • Copyright updated.
  • Disclaimer updated.
  • eMeasure version number incremented.
  • eMeasure version number incremented from 5.1.000 to 5.2.000.

Logic

  • Added logic in the Denominator Exclusions to capture patients who may have had either a normal Chest X ray or a normal CT scan in the ED which occurs before the Inpatient Encounter. In addition, logic was added as a check for patient having gotten a 'chest xray' or a 'CT scan which includes the chest' the day before or the day of arrival. Addition of the following logic satisfies both of these checks: <= 1 day(s) starts before start of Occurrence A of $EncounterInpatient<= 1 day(s) starts before start of ('Encounter, Performed: Emergency Department Visit' <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient ).
  • Added logic in the Denominator Exclusions to represent a patient with an organ transplant diagnosis any time in the past.
  • Added logic to the Denominator Exclusions related to settings from which a patient might be transferred into the inpatient hospital where they then receive treatment for pneumonia to more accurately reflect the paper based specification requirements. The settings added are an Emergency Department and an Outpatient Department.
  • Added new logic to account for reason a patient could be admitted to ICU due to pneumonia.
  • Added new logic to the Denominator Exceptions to determine if a patient had a Laboratory Test, performed: PCR test for Legionella pneumophilia (result: Positive Finding).
  • Added new logic to the Denominator Exceptions to determine if a patient had a bacterial culture which has a positive finding for bacteria as a way to determine if a patient has another source of infection. Logic is: Laboratory Test, performed: Bacterial culture (results: Positive Finding).
  • Added new logic to the Denominator Exceptions to determine if a patient had the laboratory test Urine antigen test for Legionella pneumophila or Streptococcus pneumoniae as another way to document patient had an infection. Logic added is: Laboratory Test, performed: Urine antigen test for Legionella pneumophila or Streptococcus pneumoniae (results: Positive Finding).
  • All Occurrence B instances of Encounter, Performed: Encounter Inpatient will be removed. This is an episode of care measure and the episode of care is the Inpatient Encounter.
  • All phrases containing 'Occurrence B of the Encounter, Performed: Inpatient Encounter' were removed from this eCQM. This is an episode of care measure and it only looks at one episode of an inpatient encounter, thus Occurrence B of the Inpatient Encounter is not necessary to add to the logic.
  • In the Denominator Exclusions logic about a Diagnostic Study being performed with either a normal Chest X ray or a normal CT scan, additional logic was added to capture patients who may have had one of these diagnostic studies in the ED which occurs before the Inpatient Encounter.
  • In these phrases the OR was changed to AND:- OR: 'Diagnosis, Active: Hospital Measures-Pneumonia'- OR: 'Medication, Active: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')' to capture only patients who had both of these conditions.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced the 'Intersection of' operator to specify the selection of the data sets common to all individual statements underneath the 'Intersection of'.
  • Introduced variables $InterventionComfortMeasures and $EncounterInpatient to allow re-use of logical expressions and reduce redundancy/complexity.
  • Added logic to each logic sequence in the measure where timing is related to arrival at the hospital to also account for the possibility of arrival in the ED (patient is not a direct admit). This is an example of the additional logic: 'starts during ('Encounter, Performed: Emergency Department Visit' <= 1 hour(s) ends before or concurrent with start of Occurrence A of $EncounterInpatient )'.
  • Moved logic for 'Another source of infection but not respiratory infection' documented within 24 hours after arrival at the hospital, or 'Systemic corticosteroid/prednisone therapy' within 90 days before arrival at the hospital from the Denominator Exclusions to the Denominator Exceptions.
  • Removed 'Occurrence A of' in relation to ED (if appropriate for measure intent).
  • Removed logic for patient seen and diagnosed with pneumonia in the ED which checks for septicemia and respiratory failure. Also removed ordinality of principal from the pneumonia diagnosis made in ED at steward's direction. Without the ordinality of principal for the pneumonia diagnosis, the patient will go straight to the Denominator if diagnosed in the ED with pneumonia.
  • Removed the data type of 'Intervention, performed' and replaced with 'Procedure, performed' for the data elements in the Denominator Exclusions which include 'Wound Care', 'Tracheostomy Care', and 'Ventilator Care'. Interventions refer to care given which does not involve physical contact and these actions do require physical contact, which is a procedure.
  • Removed the 'FIRST' operator from all the phrases in the Numerator of both populations which use 'Medication, administered' in combination with 'FIRST'. The phrase is 'Medication, administered <=1440 minute(s) starts after start of Encounter, performed: Inpatient Encounter (or ED). This timing satisfies the paper-based specifications that the antibiotic be administered within the first 1440 minute(s) of arrival to the hospital.
  • Removed the logic for 'Transfer from Nursing Home or Ext. Facility' was removed from the transfer from logic sequence in the Denominator Exclusions and replaced with logic representing a 'Transfer From an ED location' to reflect the paper based specification requirements.
  • Replaced 'ends before start' with 'ends before or concurrent with start of' to align across measures (when appropriate for measure intent).
  • Replaced 'ORs' with 'Union of' operator to provide a mechanism for specifying that qualifying event(s) must be a member of at least one of the data elements being unioned (if appropriate for measure intent).
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced 'starts before or during' (SBOD) with 'starts before end of' (SBE).
  • Replaced timing relationship 'starts before end of' with 'starts before or concurrent with end of' to ensure the inclusion of the end point of the element on the right-hand side of the criterion.
  • The data element in Denominators 1 and 2: 'Medication, Active: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')' was changed to: 'Medication, Administered: IV, IM, PO Antimicrobial Medications (route: 'Hospital measures-Route IV, oral or IM')' to meet the intent of the paper-based measure specifications which say the patient must have an antibiotic administered within the first 24 hours after arrival.
  • The following logic was added to the Denominator Exclusions of both Population 1 and Population 2 to cover if a patient has a normal Chest X ray or normal CT scan in the ED.Union of:-'Diagnostic Study, Result: Hospital Measures-Chest xray SM-CT (result: 'Hospital Measures-Radiological findings normal')' -'Diagnostic Study, Performed: Hospital Measures-CT scan including chest (result: 'Hospital Measures-Radiologic Finding-Normal SM-CT')' starts during 'Union of:- 'Encounter, Performed: Emergency Department Visit' <= 1 hour(s) ends before start of Occurrence A of $EncounterInpatient- Occurrence A of $EncounterInpatient'.
  • The logic for 'Transfer from Nursing Home or Ext. Facility' was removed and replaced with logic representing a Transfer From an ED location.
  • The logic which checks for systemic corticosteroid and prednisone medication use in patients was removed from the Denominator Exclusions.
  • The logic which checks for systemic corticosteroid and prednisone medication use in patients was removed from the Denominator Exclusions. It was left in the Numerator.
  • Removed logic for Clinical Trial Participant from the Denominator Exclusions.
  • The Medication, Active data element in Denominators of Population 1 and 2 was changed to the Medication, Administered data element.
  • The top level logical operator for the Numerator Exclusions, Denominator Exclusions, Denominator Exceptions, and Measure Population Exclusions defaults to 'OR'.

Value Sets

  • Replaced value set Emphysema (OID 2.16.840.1.113883.3.666.5.806) with value set Emphysema (OID: 2.16.840.1.113883.3.464.1003.102.12.1004).
  • SNOMED codes in value sets used for the data category 'diagnosis' were reviewed and were removed unless the domain was disorder, finding, situation or event.
  • The value set IV PO AntiPseudomonal Quinolones (OID 2.16.840.1.113883.3.666.5.804): Added value set to this measure.
  • Value set Acute care hospital (OID 2.16.840.1.113883.3.666.5.684): Updated value set name form Hospital Measures-Acute care hospital to Acute care hospital and deleted 15 SNOMED codes and add 1 SNOMED code.
  • Value set Ambulatory surgical center (OID 2.16.840.1.113883.3.666.5.687): Updated value set name from Hospital Measures-Ambulatory surgical center to Ambulatory surgical center.
  • Value set Another Source of Infection (OID: 2.16.840.1.113762.1.4.1111.28): Added value set to this measure.
  • Value set Any infection (OID 2.16.840.1.113883.3.666.5.696): Removed value set and replaced with new value set: Another Source of Infection (OID 2.16.840.1.113762.1.4.1111.28).
  • Value set Bacterial Culture (OID: 2.16.840.1.113762.1.4.1111.22): Added value set to this measure.
  • Value set Beta lactams for allergy determination (OID 2.16.840.1.113883.3.666.5.1058): Updated value set name from Hospital Measures-Beta lactams for allergy determination to Beta Lactams for Allergy Determination and added 1 RXNORM code (203117).
  • Value set Bronchiectasis (OID 2.16.840.1.113883.3.666.5.773): Updated value set name from Hospital Measures-Bronchiectasis to Bronchiectasis and added 1 ICD10CM codes (J47.0).
  • Value set Chest XRay Diagnostic Test (OID 2.16.840.1.113762.1.4.1111.41): Added OID 2.16.840.1.113883.3.666.5.678. Deleted 18 SNOMED codes and added 76 LOINC codes, 2 ICD9CM, and 1 ICD10PCS codes.
  • Value set Chronic bronchitis (OID 2.16.840.1.113883.3.666.5.775): Updated value set name from Hospital Measures-Chronic bronchitis to Chronic bronchitis, deleted 5 SNOMED codes (185086009, 195949008, 233672007, 32544004, 89099002), added 1 ICD9CM (491.0) and 1 SNOMED code(425748003).
  • Value set Clinical Trial Participant (OID 2.16.840.1.113883.3.526.2.643): Removed value set from this measure.
  • Value set COPD (OID 2.16.840.1.113883.3.666.5.776): Updated value set name from Hospital Measures-COPD to COPD. Added 2 ICD10CM (J44.0, J44.1) and 2 ICD9CM codes (491.21, 491.22).
  • Value set CT Scan Including Chest Diagnostic Test (OID: 2.16.840.1.113762.1.4.1111.42): Created a new value set with 45 ICD10PCS codes and 19 LOINC codes and added OID 2.16.840.1.113883.3.666.5.680. Deleted 7 SNOMED codes ( 169069000, 41540006, 241541005, 41542003, 303668008, 443145004, 44323700) and added 1 ICD9CM code (87.41).
  • Value Set Cystic Fibrosis (OID 2.16.840.1.113883.3.464.1003.102.12.1002): Added to the measure to replace value set Value set Hospital Measures-Cystic Fibrosis (OID 2.16.840.1.113883.3.666.5.682).
  • Value set Diagnoses As Reasons For Admission To ICU due To Pneumonia (OID 2.16.840.1.113762.1.4.1045.84): Updated value set from Reason For Admission to ICU due to Pneumonia to Diagnoses As Reasons For Admission To ICU due To Pneumonia. Added 18 ICD10CM, 12 ICD9CM, and 20 SNOMED codes, and deleted 15 ICD10PCS, 12 ICD10PCS, and 33 SNOMED codes. Another value set was developed which contains codes for procedures which would be a reason to admit a patient to ICU (OID 2.16.840.1.113762.1.4.1111.26) and which is named Procedures as Reasons for Admission to ICU Due to Pneumonia.
  • Value Set Emergency Department Visit (OID 2.16.840.1.113883.3.117.1.7.1.292): Added value set to this measure.
  • Value set Francisella Tularensis or Yersinia pestis (OID 2.16.840.1.113883.3.666.5.2205): Updated value set from Hospital Measures-Francisella Tularensis or Yersinia pestis to Francisella Tularensis or Yersinia pestis. Deleted 2 ICD10CM (A20.8, A20.9) and 2 SNOMED (36753006, 58750007) codes.
  • Value set Hemodialysis or peritoneal dialysis (OID 2.16.840.1.113883.3.666.5.2282): Updated the value set name from Hospital measures-Hemodialysis or peritoneal dialysis to Hemodialysis or Peritoneal Dialysis and added 2 SNOMED codes (302497006, 71192002).
  • Value set Hospital Measures-Neutrophil count (OID 2.16.840.1.113883.3.666.5.787): Removed value set from this measure.
  • Value set Hospital Measures-Organ transplant (OID 2.16.840.1.113883.3.666.5.801): Removed value set from this measure.
  • Value set Immunocompromised Conditions (OID 2.16.840.1.113883.3.666.5.1940): Updated value set name from Hospital Measures-Immunocompromised Conditions to Immunocompromised Conditions. Deleted 10 ICD10CM, 7 ICD9CM, and 5 SNOMED codes and added 70 ICD10CM and 72 ICD9CM.
  • Value set Immunocompromised Therapies (OID 2.16.840.1.113883.3.666.5.2348): Updated value set name from Hospital Measures-Immunocompromised Therapies to Immunocompromised Therapies.
  • Value set Immunodeficient Conditions (OID 2.16.840.1.113883.3.666.5.1726): Updated value set name from Hospital Measures-Immunodeficient Conditions to Immunodeficient Conditions. Deleted 1 ICD10CM code, 3 ICD9CM codes, 20 SNOMED codes and added 7 ICD10CM codes, 4 ICD9CM codes, and 16 SNOMED codes.
  • Value set Interstital lung disease (OID 2.16.840.1.113883.3.666.5.777): Updated value set name from Hospital Measures-Interstital lung disease to Interstital lung disease and deleted 5 SNOMED codes (28168000, 45157009, 68759006, 74455006, 84234002).
  • Value set IV Aminoglycosides (OID 2.16.840.1.113883.3.666.5.727): Updated value set name from Hospital Measures-IV Aminoglycosides to IV Aminoglycosides.
  • Value set IV Antipneumococcal/antipseudomonal beta lactams (OID 2.16.840.1.113883.3.666.5.759): Updated value set name from Hospital Measures-IV Antipneumococcal/antipseudomonal beta lactams to IV Antipneumococcal/antipseudomonal beta lactams.
  • Value set IV Antipseudomonal quinolones (OID 2.16.840.1.113883.3.666.5.896): Updated value set name from Hospital Measures-IV Antipseudomonal quinolones to IV Antipseudomonal quinolones.
  • Value set IV Beta lactams (OID 2.16.840.1.113883.3.666.5.770): Updated value set name from Hospital Measures-IV Beta lactams to IV Beta lactams.
  • Value set IV Doxycycline (OID 2.16.840.1.113883.3.666.5.2204): Updated value set name from Hospital Measures-IV Tetracycline to IV Doxycycline.
  • Value set IV Macrolides ICU (OID 2.16.840.1.113883.3.666.5.758): Updated value set name from Hospital Measures-IV Macrolides ICU to IV Macrolides ICU and added 1 RXNORM code (686354).
  • Value set IV or IM Aztreonam (OID 2.16.840.1.113883.3.666.5.779): Updated value set name from Hospital Measures-IV or IM Aztreonam to IV or IM Aztreonam.
  • Value set IV or IM Beta lactams (OID 2.16.840.1.113883.3.666.5.720): Updated value set name from Hospital Measures-IV or IM Beta lactams to IV or IM Beta lactams and added 2 RXNORM codes (308207,313819).
  • Value set IV Or PO Doxycyclines (OID 2.16.840.1.113883.3.666.5.840): Updated value set name from Hospital Measures-IV or PO Tetracyclines to IV Or PO Doxycyclines and added 1 RXNORM code (1423080).
  • Value set IV or PO Levofloxacin (OID 2.16.840.1.113883.3.666.5.760): Updated value set name from Hospital Measures-IV or PO Levofloxacin to IV or PO Levofloxacin.
  • Value set IV or PO Macrolides Non-ICU (OID 2.16.840.1.113883.3.666.5.772): Updated value set name from Hospital Measures-IV or PO Macrolides Non-ICU to IV or PO Macrolides Non ICU. Added 5 RXNORM codes (597298, 686354, 686383, 997999, 998004) and deleted 1 RXNORM code (597194).
  • Value set IV PO Quinolone Antipneumococcal (OID 2.16.840.1.113883.3.666.5.463): Updated value set name from Hospital Measures-IV PO Quinolone Antipneumococcal to IV PO Quinolone Antipneumococcal and added 1 RXNORM (311787) code.
  • Value set IV Quinolones Antipneumococcal (OID 2.16.840.1.113883.3.666.5.465): Updated value set name from Hospital Measures-IV Quinolones Antipneumococcal to IV Quinolones Antipneumococcal.
  • Value set IV Tigecycline (OID 2.16.840.1.113883.3.666.5.2203): Updated value set name from Hospital Measures-IV Tigecycline to IV Tigecycline.
  • Value set IV, IM, PO Antimicrobial Medications (OID 2.16.840.1.113883.3.666.5.693): Deleted 5 RXNORM codes (204931, 240639, 476193, 476299, 197456).
  • Value set Nursing Home or Ext Fac Transfer (OID 2.16.840.1.113883.3.666.5.2202): Updated value set name from Hospital Measures-Nursing Home or Ext Fac Transfer to Nursing Home or Extended Care Facility. Added 2 SNOMED codes (32074000, 80522000) and deleted 8 SNOMED codes (183919006, 183920000, 183921001, 304567001, 305340004, 305347001, 305348006, 36723004).
  • Value set Organ Transplant Recipient (OID: 2.16.840.1.113762.1.4.1111.27): Added value set to this measure.
  • Value Set PCR test for Legionella pneumophilia (OID:2.16.840.1.113762.1.4.1111.23): Added value set to this measure.
  • Value set Pneumonia (OID 2.16.840.1.113883.3.666.5.752): Updated value set name from Hospital Measures-Pneumonia to Pneumonia and deleted 5 SNOMED codes (17688001, 18400002, 56415008, 58720004, 65186004).
  • Value Set Positive Finding (OID: 2.16.840.1.113883.3.464.1003.195.11.1008): Added value set to this measure.
  • Value set Prolonged QT Interval (OID 2.16.840.1.113883.3.666.5.2197): Updated value set name from Hospital Measures-Prolonged QT Interval to Prolonged QT Interval.
  • Value set Radiologic Finding-Normal SM-CT (OID 2.16.840.1.113883.3.666.5.2365): Updated value set name from Hospital Measures-Radiologic Finding-Normal SM-CT to Radiologic Finding Normal and deleted 2 SNOMED codes (168733007, 169064005).
  • Value set Respiratory failure acute or chronic (OID 2.16.840.1.113883.3.666.5.2319): Updated value set name from Hospital Measures-Respiratory failure acute or chronic to Respiratory failure acute or chronic. Added 5 ICD10CM codes (J95.821, J95.822, J96.10, J96.11, J96.12) and 4 SNOMED codes (397767007, 39871006, 426896000, 428173007).
  • Value set Respiratory infection (OID 2.16.840.1.113883.3.666.5.2162): Updated value set name from Hospital Measures-Respiratory infection to Respiratory infection. Deleted 1 SNOMED, 12 ICD10CM, and 8 ICD9CM codes.
  • Value set Restrictive lung disease (OID 2.16.840.1.113883.3.666.5.2160): Updated value set name from Hospital Measures-Restrictive lung disease to Restrictive lung disease.
  • Value set Route IV or PO (OID 2.16.840.1.113883.3.666.5.1112): Updated value set name from Hospital Measures-Route IV or PO to Route IV or PO.
  • Value set Route IV/IM (OID 2.16.840.1.113883.3.666.5.1109): Updated value set name from Hospital Measures-Route IV/IM to Route IV/IM.
  • Value set Septicemia (OID 2.16.840.1.113883.3.666.5.672): Updated value set name from Hospital Measures-Septicemia to Septicemia. Deleted 100 SNOMED codes and added 5 ICD10CM codes (A26.7, A32.7, A41.01, A41.02, B37.7).
  • Value set Structural lung disease (OID 2.16.840.1.113883.3.666.5.774): Updated value set name from Hospital Measures-Structural lung disease to Structural lung disease.
  • Value set Substance Or Medication Administration Route IV (OID 2.16.840.1.113883.3.666.5.1108): Updated value set name from Hospital measures-Route IV to Substance or Medication Administration Route IV.
  • Value set Substance Or Medication Administration Route IV Oral Or IM (OID 2.16.840.1.113883.3.666.5.1111): Updated the value set name from Hospital measures-Route IV, oral or IM to Substance Or Medication Administration Route IV, oral or IM and deleted 1 SNOMED code (272394005).
  • Value set Systemic corticosteroid/prednisone therapy (OID 2.16.840.1.113883.3.666.5.805): Updated value set name from Hospital Measures-Systemic corticosteroid/prednisone therapy to Systemic corticosteroid/prednisone therapy. Added 1 RXNORM (1244214) and deleted 4 RXNORM codes (1244211, 197585, 309688, 436508).
  • Value set Systemic immunosuppressive therapy (OID 2.16.840.1.113883.3.666.5.803): Updated value set name from Hospital Measures-Systemic immunosuppressive therapy to Systemic immunosuppressive therapy. Deleted 20 RXNORM codes and added 16 RXNORM codes.
  • Value Set Tracheostomy care (OID 2.16.840.1.113762.1.4.1045.77): Deleted 1 ICD10CM code (V55.0) and added 1 ICD10CM code (Z43.0).
  • Value set Transfer From Outpatient (OID 2.16.840.1.113883.3.67.1.101.950): Added value set to this measure.
  • Value set Urine antigen test for Legionella pneumophila or Streptococcus pneumoniae (OID: 2.16.840.1.113762.1.4.1111.20): Added value set to this measure.
  • Value set Ventilator care (OID 2.16.840.1.113883.3.666.5.782): Updated value set name from Hospital Measures-Ventilator care to Ventilator care.
  • Value set Wound Care (OID 2.16.840.1.113883.3.666.5.2192): Updated value set name from Hospital Measures-Wound Care to Wound Care.

XML

  • This measure contains multiple Population Criteria sections. The earlier version of this measure contained mismatches between the applicable Population Criteria human readable narrative sections and their associated computer-readable sections in the XML file. This issue has been corrected.

External Resources