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Appropriate Treatment for Upper Respiratory Infection (URI)

Compare Versions of: "Appropriate Treatment for Upper Respiratory Infection (URI)"

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 Treatment for Upper Respiratory Infection (URI) Appropriate Treatment for Upper Respiratory Infection (URI) Appropriate Treatment for Upper Respiratory Infection (URI)
CMS eCQM ID CMS154v10 CMS154v11 CMS154v12
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 order

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 (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

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 from January 1 to December 28 of the measurement period for 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 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. 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 where the patient is taking antibiotics in the 30 days prior to the episode date.Exclude URI episodes where the patient had competing diagnosis on or three days after the episode date.
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 three 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 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.

This is an episode of care measure that examines all eligible episodes for the patient.

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 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 065 065 065
Telehealth Eligible Yes Yes Yes
Next Version No Version Available
Previous Version No Version Available

Header

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated the rationale based upon more recent literature and evidence to support the measure.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated the clinical recommendation statement based upon more recent literature and evidence to support the measure.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • 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

  • 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

  • Refined timing language and standardized it across similar measures.

    Measure Section: Numerator

    Source of Change: Test Case Review

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

    Measure Section: Multiple Sections

    Source of Change: Annual Update

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

  • Replaced value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001) with value set Antibiotic Medications for Upper Respiratory Infection (2.16.840.1.113883.3.464.1003.1190) to capture a different list of appropriate antibiotic medications for this measure.

    Measure Section: Numerator

    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

  • 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

  • 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

  • Replaced value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001) with value set Antibiotic Medications for Upper Respiratory Infection (2.16.840.1.113883.3.464.1003.1190) to capture a different list of appropriate antibiotic medications for this measure.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • 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

  • 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

  • Replaced value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001) with value set Antibiotic Medications for Upper Respiratory Infection (2.16.840.1.113883.3.464.1003.1190) 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 review by technical experts, SMEs, and/or public feedback. Added 1187 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 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 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

  • Value set Upper Respiratory Infection (2.16.840.1.113883.3.464.1003.102.12.1022): Deleted 1 SNOMED CT code (78337007) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Jan 22, 2024