Appropriate Testing for Pharyngitis
Compare Versions of: "Appropriate Testing for Pharyngitis"
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| Measure Information | 2022 Performance Period | 2023 Performance Period | 2024 Performance Period | 2025 Performance Period |
|---|---|---|---|---|
| Title | Appropriate Testing for Pharyngitis | Appropriate Testing for Pharyngitis | Appropriate Testing for Pharyngitis | Appropriate Testing for Pharyngitis |
| CMS eCQM ID | CMS146v10 | CMS146v11 | CMS146v12 | CMS146v13 |
| CBE ID* | Not Applicable | Not Applicable | Not Applicable | Not Applicable |
| MIPS Quality ID | 066 | 066 | 066 | 066 |
| Measure Steward | National Committee for Quality Assurance | National Committee for Quality Assurance | National Committee for Quality Assurance | National Committee for Quality Assurance |
| 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 |
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 |
| Measure Scoring | Proportion measure | Proportion measure | Proportion measure | Proportion measure |
| Measure Type | Process | Process | Process | Process |
| Stratification | *See CMS146v10.html | *See CMS146v11.html |
- 3-17 years - 18-64 years - 65 years and older |
- 3-17 years - 18-64 years - 65 years and older |
| Risk Adjustment | *See CMS146v10.html | *See CMS146v11.html |
None |
None |
| Rationale | *See CMS146v10.html | *See CMS146v11.html |
Group A streptococcal (GAS) bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (Shulman et al., 2012). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al., 2005). Estimated economic costs of pediatric streptococcal pharyngitis in the United States range from $224 million to $539 million per year, including indirect costs related to parental work losses. At a higher level, the economic cost of antibiotic resistance varies but has extended as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars) (Pfoh et al., 2008). |
Group A streptococcal (GAS) bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (Shulman et al., 2012). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al., 2005). Estimated economic costs of pediatric streptococcal pharyngitis in the United States range from $224 million to $539 million per year, including indirect costs related to parental work losses. At a higher level, the economic cost of antibiotic resistance varies but has extended as high as $20 billion in excess direct healthcare costs, with additional costs to society for lost productivity as high as $35 billion a year (2008 dollars) (Pfoh et al., 2008). |
| Clinical Recommendation Statement | *See CMS146v10.html | *See CMS146v11.html |
Infectious Disease Society of America (2012) The Infectious Diseases Society of America "recommends swabbing the throat and testing for GAS pharyngitis by rapid antigen detection test (RADT) and/or culture because the clinical features alone do not reliably discriminate between GAS and viral pharyngitis except when overt viral features like rhinorrhea, cough, oral ulcers, and/or hoarseness are present" |
Infectious Disease Society of America (Shulman et al., 2012) The Infectious Diseases Society of America "recommends swabbing the throat and testing for GAS pharyngitis by rapid antigen detection test (RADT) and/or culture because the clinical features alone do not reliably discriminate between GAS and viral pharyngitis except when overt viral features like rhinorrhea, cough, oral ulcers, and/or hoarseness are present" |
| Improvement Notation |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
Higher score indicates better quality |
| Definition | *See CMS146v10.html | *See CMS146v11.html |
None |
None |
| 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. |
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. |
| 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 |
Outpatient, telephone, virtual encounter (i.e., e-visit or virtual check-in), 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 |
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. |
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 |
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 |
Not Applicable |
| Denominator Exceptions |
None |
None |
None |
None |
| Telehealth Eligible | Yes | Yes | Yes | Yes |
| Next Version | No Version Available | |||
| Previous Version | No Version Available |
Additional Resources for CMS146v12
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