Appropriate Treatment for Upper Respiratory Infection (URI)

Measure Information	2021 Performance Period
CMS Measure ID	CMS154v9
NQF Number	Not Applicable
Measure Description	Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event.
Initial Population	Outpatient visits, telephone visits, online assessments, observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older.
Denominator Statement	Equals Initial Population
Denominator Exclusions	Exclude URI episodes when the patient had a competing comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had a new or refill prescription of antibiotics in the 30 days prior to or on the episode date. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care overlapping with the measurement period.
Numerator Statement	URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection
Numerator Exclusions	Not Applicable
Denominator Exceptions	None
Measure Steward	National Committee for Quality Assurance
Quality Domain	Efficiency and Cost Reduction
Measure Scoring	Proportion measure
Measure Type	Process measure
Improvement Notation	Higher score indicates better quality
Guidance	This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. This eCQM is a episode-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.
MIPS Quality ID	065
Meaningful Measure	Appropriate Use of Healthcare
Telehealth Eligible	Yes
Next Version	CMS154v10
Previous Version	No Version Available

Compare eCQM Versions

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

Strikethrough text highlighted in red indicates information changed from the previous version. Text highlighted in green indicates information updated in the new eCQM version.

Filter Measure By

Download

Measure Information	2021 Performance Period	2022 Performance Period	2023 Performance Period
CMS Measure ID	CMS154v9	CMS154v10	CMS154v11
NQF Number	Not Applicable	Not Applicable	Not Applicable
Measure Description	Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event.	Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event.	Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic order
Initial Population	Outpatient visits, telephone visits, online assessments, observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older.	Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older.	Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older
Denominator Statement	Equals Initial Population	Equals Initial Population	Equals Initial Population
Denominator Exclusions	Exclude URI episodes when the patient had a competing comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had a new or refill prescription of antibiotics in the 30 days prior to or on the episode date. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care overlapping with the measurement period.	Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date, including the episode date up until the time of the encounter. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care for any part of the measurement period.	Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date but is still active the same day of the encounter.Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date.Exclude URI episodes when the patient had hospice care for any part of the measurement period.
Numerator Statement	URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection	URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection	URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection
Numerator Exclusions	Not Applicable	Not Applicable	Not Applicable
Denominator Exceptions	None	None	None
Measure Steward	National Committee for Quality Assurance	National Committee for Quality Assurance	National Committee for Quality Assurance
Quality Domain	Efficiency and Cost Reduction	Efficiency and Cost Reduction	Efficiency and Cost Reduction
Measure Scoring	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process measure	Process measure	Process measure
Improvement Notation	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality
Guidance	This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. This eCQM is a episode-based measure. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.	This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection during the measurement period. This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.	This is an episode of care measure that examines all eligible episodes for the patient during the measurement period. This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 months of age and older with a diagnosis of upper respiratory infection during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.
MIPS Quality ID	065	065	065
Meaningful Measure	Appropriate Use of Healthcare	Appropriate Use of Healthcare	Appropriate Use of Healthcare
Telehealth Eligible	Yes	Yes	Yes
Next Version	CMS154v10	CMS154v11	No Version Available
Previous Version	No Version Available	CMS154v9	CMS154v10

Download XML

Download CSV

Specifications

Attachment	Size
CMS154v9.html	64.2 KB
CMS154v9.zip	70.37 KB
CMS154v9-TRN.xlsx	22.66 KB

Data Element Repository

Data Elements contained within CMS154v9

Value Sets

Value Sets to be used with CMS154v9

Release Notes

CMS154v9-TRN.xlsx

Header

Increased the age range age to 3 months and older, from 3 months to 18 years, to address the increasing alarm regarding antibiotic overuse among all age ranges.

Measure Section: eCQM Title

Source of Change: Measure Lead
Updated eCQM Version Number.

Measure Section: eCQM Version Number

Source of Change: Standards Update
Increased the age range age to 3 months and older, from 3 months to 18 years, to address the increasing alarm regarding antibiotic overuse among all age ranges.

Measure Section: Description

Source of Change: Measure Lead
Updated the description and numerator statements to be episode based for better alignment with the measure intent.

Measure Section: Description

Source of Change: Measure Lead
Updated copyright.

Measure Section: Copyright

Source of Change: Annual Update
Updated references.

Measure Section: Reference

Source of Change: Annual Update
Added text to identify the Quality Data Model (QDM) version used in the measure specification.

Measure Section: Guidance

Source of Change: Standards Update
Added text to indicate whether the measure is patient-based or episode-based.

Measure Section: Guidance

Source of Change: Standards Update
Increased the age range age to 3 months and older, from 3 months to 18 years, to address the increasing alarm regarding antibiotic overuse among all age ranges.

Measure Section: Initial Population

Source of Change: Measure Lead
Updated denominator exclusions for upper respiratory infection (URI) to clarify language regarding eligible encounter types and add an exclusion for competing comorbid condition during the 12 months prior to or on the episode date.

Measure Section: Denominator Exclusions

Source of Change: Measure Lead
Increased the age range age to 3 months and older, from 3 months to 18 years, to address the increasing alarm regarding antibiotic overuse among all age ranges.

Measure Section: Numerator

Source of Change: Measure Lead
Updated the description and numerator statements to be episode based for better alignment with the measure intent.

Measure Section: Numerator

Source of Change: Measure Lead

Logic

Increased the age range age to 3 months and older, from 3 months to 18 years, to address the increasing alarm regarding antibiotic overuse among all age ranges.

Measure Section: Initial Population

Source of Change: Measure Lead
Updated denominator exclusions for upper respiratory infection (URI) to clarify language regarding eligible encounter types and add an exclusion for competing comorbid condition during the 12 months prior to or on the episode date.

Measure Section: Denominator Exclusions

Source of Change: Measure Lead
Increased the age range age to 3 months and older, from 3 months to 18 years, to address the increasing alarm regarding antibiotic overuse among all age ranges.

Measure Section: Numerator

Source of Change: Measure Lead
Added 'on or' to the 'Encounter with Competing Diagnosis for Upper Respiratory Infection' definition to allow for same day competing diagnosis.

Measure Section: Definitions

Source of Change: ONC Project Tracking System (Jira): CQM-3789
QDM v5.5 standards update: Added 'relevantDatetime' attribute to QDM datatypes. 'RelevantDatetime' indicates when the action occurred whereas 'authorDatetime' indicates when the action was recorded.

Measure Section: Multiple Sections

Source of Change: Standards Update
Updated Clinical Quality Language (CQL) expression to conform with the HL7 Standard: Clinical Quality Language Specification, Release 1 STU 4 (CQL 1.4).

Measure Section: Multiple Sections

Source of Change: Standards Update
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

Measure Section: Multiple Sections

Source of Change: Standards Update
Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-5.0.000). Updated definitions and functions in the MAT Global Common Functions Library to align with standards changes, CQL Style Guide, and to include one new function related to calculating length of hospital stays with observation stays.

Measure Section: Multiple Sections

Source of Change: Standards Update
CQL Library version update: Updated version number of the Hospice Library (Hospice-2.2.000).

Measure Section: Multiple Sections

Source of Change: Measure Lead

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Deleted 9 RxNorm codes (1148107, 199497, 199620, 199710, 199802, 245240, 245837, 245838, 761979) based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update
Value set Competing Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1017): Deleted 29 SNOMED CT codes based on terminology update.

Measure Section: Terminology

Source of Change: Annual Update
Value sets Preventive Care Services - Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025); Preventive Care Services - Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023); Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080) added to accommodate the expanded age range of the initial population.

Measure Section: Terminology

Source of Change: Measure Lead
Value set Comorbid Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1025): Added Comorbid Conditions for Respiratory Conditions based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead