Appropriate Treatment for Upper Respiratory Infection (URI)

Measure Information	2022 Performance Period
CMS eCQM ID	CMS154v10
NQF Number	Not Applicable
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 (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	Equals Initial Population
Denominator Exclusions	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.
Numerator	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
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 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 for more information on the QDM.
MIPS Quality ID	065
Telehealth Eligible	Yes
Next Version	CMS154v11
Previous Version	CMS154v9

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Measure Information	2021 Performance Period	2022 Performance Period	2023 Performance Period
Title	Appropriate Treatment for Upper Respiratory Infection (URI)	Appropriate Treatment for Upper Respiratory Infection (URI)	Appropriate Treatment for Upper Respiratory Infection (URI)
CMS eCQM ID	CMS154v9	CMS154v10	CMS154v11
NQF Number	Not Applicable	Not Applicable	Not Applicable
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	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	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
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 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
Telehealth Eligible	Yes	Yes	Yes
Next Version	CMS154v10	CMS154v11	No Version Available
Previous Version	No Version Available	CMS154v9	CMS154v10

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CMS154v10.html	80.35 KB
CMS154v10.zip	80.67 KB
CMS154v10-TRN.xlsx	20.08 KB

Data Element Repository

Data Elements contained within CMS154v10

Value Sets

Value Sets to be used with CMS154v10

Release Notes

CMS154v10-TRN.xlsx

Header

Updated the eCQM version number.

Measure Section: eCQM Version Number

Source of Change: Annual Update
Updated copyright.

Measure Section: Copyright

Source of Change: Annual Update
Updated the rationale to align with current evidence.

Measure Section: Rationale

Source of Change: Measure Lead
Updated references.

Measure Section: Reference

Source of Change: Annual Update
Updated the guidance to clarify the measure intent and support implementation.

Measure Section: Guidance

Source of Change: Measure Lead
Added clarifying language to guidance section of episode-based measures to define the episode.

Measure Section: Guidance

Source of Change: Measure Lead
Revised language in the inital population to reduce ambiguity and improve clarity.

Measure Section: Initial Population

Source of Change: Measure Lead
Replaced 'overlaps' or 'overlapping' in the denominator exclusions with plain language to clarify the measure intent.

Measure Section: Denominator Exclusions

Source of Change: Measure Lead
Revised the denominator exclusions language to reduce ambiguity in the exclusions.

Measure Section: Denominator Exclusions

Source of Change: Measure Lead

Logic

Harmonized the types of encounters considered denominator eligible to align with the measure intent and measures of similar type.

Measure Section: Initial Population

Source of Change: Measure Lead
Restructured the return on the Encounter with Competing Diagnosis for Upper Respiratory Infection definition to reduce confusion for implementers.

Measure Section: Definitions

Source of Change: Measure Lead
Revised the definitions to base timing of measure criteria on the time of the encounter to align with the measure intent to use encounter information to determine valid time intervals for conditions/medications.

Measure Section: Definitions

Source of Change: Measure Lead
Added online assessments as appropriate encounters based on the increased use of telehealth services.

Measure Section: Multiple Sections

Source of Change: Measure Lead
Updated Hospice CQL Library to version 3.0.000.

Measure Section: Multiple Sections

Source of Change: Measure Lead
Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-6.2.000). Updated the 'Inpatient Encounter' definition to include a 'day of' timing clarification. Added the following timing functions: Normalize Interval, Has Start, Has End, Latest, Latest Of, Earliest, and Earliest Of. Please see individual measure details for application of specific timing functions.

Measure Section: Multiple Sections

Source of Change: Standards Update
Added new NormalizeInterval function to timing attributes to decrease implementation burden due to variable use of timing attributes for select QDM data types. The NormalizeInterval function was applied, where applicable, for the following data elements: Assessment, Performed; Device, Applied; Diagnostic Study, Performed; Intervention, Performed; Laboratory Test, Performed; Medication, Administered; Medication, Dispensed; Physical Exam, Performed; Procedure, Performed; Substance, Administered.

Measure Section: Multiple Sections

Source of Change: Standards Update

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): Added 2 RxNorm codes (2387078, 2387079) based on terminology update. Deleted 24 RxNorm codes 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): Added 1269 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback or based on terminology update. Deleted 1159 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback. Added 5 ICD-10-CM codes (B60.00, B60.01, B60.02, B60.03, B60.09) based on review by technical experts, SMEs, and/or public feedback. Deleted 37 ICD-10-CM codes based on review by technical experts, SMEs, and/or public feedback.

Measure Section: Terminology

Source of Change: Measure Lead
Value set Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080): Added 5 SNOMED CT codes (185317003, 314849005, 386472008, 386473003, 401267002) based on change in measure requirements/measure specification.

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 9 SNOMED CT codes (22607003, 266355005, 307202004, 74610006, 76157009, 782761005, 789056000, 789057009, 860803004) based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations. Added 14 ICD-10-CM codes based on updated evidence in published guidelines, published literature, or from published specialty medical society or group recommendations.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Medical Disability Exam (2.16.840.1.113883.3.464.1003.101.12.1073) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Preventive Care Services-Individual Counseling (2.16.840.1.113883.3.464.1003.101.12.1026) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Preventive Care Services - Group Counseling (2.16.840.1.113883.3.464.1003.101.12.1027) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Observation (2.16.840.1.113883.3.464.1003.101.12.1086) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Online Assessments (2.16.840.1.113883.3.464.1003.101.12.1089) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added direct reference code CPT code (99217) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Outpatient Consultation (2.16.840.1.113883.3.464.1003.101.12.1008) based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead
Added value set Preventive Care Services - Other (2.16.840.1.113883.3.464.1003.101.12.1030) based on based on change in measure requirements/measure specification.

Measure Section: Terminology

Source of Change: Measure Lead