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Appropriate Testing for Pharyngitis

Compare Versions of: "Appropriate Testing for Pharyngitis"

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.

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Measure Information 2022 Performance Period 2023 Performance Period 2024 Performance Period
Title Appropriate Testing for Pharyngitis Appropriate Testing for Pharyngitis Appropriate Testing for Pharyngitis
CMS eCQM ID CMS146v10 CMS146v11 CMS146v12
NQF Number Not Applicable Not Applicable Not Applicable
Description

The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic dispensing event and a group A streptococcus (strep) test

The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order and a group A streptococcus (strep) test in the seven-day period from three days prior to the episode date through three days after the episode date

The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order on or three days after the episode date and a group A streptococcus (strep) test in the seven-day period from three days prior to the episode date through three days after the episode date

Initial Population

Outpatient, telephone, online assessment (i.e. e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis and an antibiotic dispensing event on or within 3 days after the episode date among patients 3 years or older

Outpatient, telephone, online assessment (i.e. e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis or tonsillitis and an antibiotic order on or within 3 days after the episode date among patients 3 years or older

Outpatient, telephone, online assessment (i.e., e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis or tonsillitis from January 1 to December 28 of the measurement period and an antibiotic order on or three days after the episode date among patients 3 years or older

Denominator

Equals Initial Population

Equals Initial Population

Equals Initial Population

Denominator Exclusions Exclude episodes where the patient is taking antibiotics in the 30 days prior to the episode date, or had an active prescription on the episode date.Exclude episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date.Exclude episodes when the patient had hospice care for any part of the measurement period.Exclude episodes where the patient had a competing diagnosis on or within three days after the episode date. Exclude episodes where the patient is taking antibiotics in the 30 days prior to the episode date, or had an active prescription on the episode date.Exclude episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date.Exclude episodes when the patient had hospice care for any part of the measurement period.Exclude episodes where the patient had a competing diagnosis on or within three days after the episode date. Exclude pharyngitis episodes when the patient had hospice care for any part of the measurement period.Exclude pharyngitis episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date.Exclude pharyngitis episodes where the patient is taking antibiotics in the 30 days prior to the episode date.Exclude pharyngitis episodes where the patient had a competing diagnosis on or three days after the episode date.
Numerator

A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date

A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date

A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date

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. The intent is to determine whether antibiotics are being dispensed appropriately. Antibiotics should only be dispensed if a strep test has been performed to confirm a bacterial infection. Antibiotics should not be dispensed for viral infections.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic dispensing event 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. The intent is to determine whether antibiotics are being ordered appropriately. Antibiotics should only be ordered if a strep test has been performed to confirm a bacterial infection. Antibiotics should not be ordered for viral infections. Antibiotics should be ordered on the episode date through 3 days after the episode date.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order 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.

This is an episode of care measure that examines all eligible episodes for the patient. The intent is to determine whether antibiotics are being ordered appropriately. Antibiotics should only be ordered if a strep test has been performed to confirm a bacterial infection. Antibiotics should not be ordered for viral infections. Antibiotics should be ordered on or three days after the episode date.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order from January 1 to December 28 of 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 066 066 066
Telehealth Eligible Yes Yes Yes
Next Version No Version Available
Previous Version No Version Available

Header

  • Updated language to clarify the different timing criteria for the antibiotic order and the strep test.

    Measure Section: Description

    Source of Change: Measure Lead

  • Refined timing language and standardized it across similar measures.

    Measure Section: Description

    Source of Change: Test Case Review

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated grammar, wording, and/or formatting to improve readability and consistency.

    Measure Section: Stratification

    Source of Change: Annual Update

  • Refined timing language and standardized it across similar measures.

    Measure Section: Guidance

    Source of Change: Test Case Review

  • Revised language to collect all data by the end of the measurement period in harmonization with program standards by applying a denominator data collection cap on December 28th of the measurement period.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated grammar, wording, and/or formatting to improve readability and consistency.

    Measure Section: Initial Population

    Source of Change: Annual Update

  • Refined timing language and standardized it across similar measures.

    Measure Section: Initial Population

    Source of Change: Test Case Review

  • Revised language to collect all data by the end of the measurement period in harmonization with program standards by applying a denominator data collection cap on December 28th of the measurement period.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Updated the denominator exclusion language to improve clarity of measure intent, alignment across similar measures and alignment with the logic.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

Logic

  • Updated the order in which denominator exclusions are listed and adjusted definition names to improve clarity of measure intent, alignment across similar measures and alignment with the header.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Updated the version number of the Hospice Library to v5.0.000.

    Measure Section: Definitions

    Source of Change: Annual Update

  • Updated the order in which denominator exclusions are listed and adjusted definition names to improve clarity of measure intent, alignment across similar measures and alignment with the header.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Definitions

    Source of Change: Standards/Technical Update

  • Removed direct reference code CPT code 99217 from the 'Qualifying Encounters' definition due to terminology update.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added QDM datatype 'Diagnosis' to the Hospice.'Has Hospice Services' definition referencing a new value set containing SNOMED finding codes to provide an additional approach for identifying patients receiving hospice care.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Added 'day of' specificity to hospice expressions for consistency.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Revised the logic to collect all data by the end of the measurement period in harmonization with program standards by applying a denominator data collection cap on December 28th of the measurement period.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the version number of the Hospice Library to v5.0.000.

    Measure Section: Functions

    Source of Change: Annual 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.

  • Deleted direct reference code CPT code (99217) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Added 3 RxNorm codes (1801142, 2604801, 2604803) based on review by technical experts, SMEs, and/or public feedback.

    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 4910 SNOMED CT codes based on change in measure requirements/measure specification. Added 1187 ICD-10-CM codes based on change in measure requirements/measure specification.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Competing Conditions for Respiratory Conditions (2.16.840.1.113883.3.464.1003.102.12.1017): Added 1 SNOMED CT code (449908004) based on review by technical experts, SMEs, and/or public feedback. Added 9 ICD-10-CM codes (K05.20, K05.211, K05.212, K05.213, K05.219, K05.221, K05.222, K05.223, K05.229) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set (2.16.840.1.113883.3.464.1003.101.12.1010): Renamed to Emergency Department Evaluation and Management Visit based on recommended value set naming conventions.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Group A Streptococcus Test (2.16.840.1.113883.3.464.1003.198.12.1012): Deleted 1 LOINC code (96331-4) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Hospice Care Ambulatory (2.16.840.1.113883.3.526.3.1584): Deleted 3 SNOMED CT codes (170935008, 170936009, 305911006) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added value set Hospice Diagnosis (2.16.840.1.113883.3.464.1003.1165) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Hospice Encounter (2.16.840.1.113883.3.464.1003.1003): Added 2 SNOMED CT codes (305911006, 385765002) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Online Assessments (2.16.840.1.113883.3.464.1003.101.12.1089): Added 4 CPT codes (98980, 98981, 99444, 99457) based on review by technical experts, SMEs, and/or public feedback. Added 3 HCPCS codes (G2250, G2251, G2252) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Jan 22, 2024