Appropriate Testing for Children with Pharyngitis

Last updated: October 25, 2017

CMS Measure ID: CMS146v6
Version: 6
NQF Number: None
Measure Description:

Percentage of children 3-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode

Initial Patient Population:

Children 3-18 years of age who had an outpatient or emergency department (ED) visit with a diagnosis of pharyngitis during the measurement period and an antibiotic ordered on or three days after the visit

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

Children who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis.

Exclude patients who were in hospice care during the measurement year.

Numerator Statement:

Children with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitis

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: National Committee for Quality Assurance
Domain: Efficiency and Cost Reduction
Previous Version: Appropriate Testing for Children with Pharyngitis
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. If the patient has more than one episode, include all episodes in the measure.

Addendum Notes: Value Set content updated Sept 2017, TRNs updated Oct 2017

Specifications

Release Notes

Header

  • ​Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • ​Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • ​Updated the exclusion statement in the header to exclude patients in hospice care from the Denominator. Measures that focus on screenings and procedures may not be appropriate or a priority for those who are at end of life (ie, on hospice).

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

Logic

  • ​Updated logic by tying the diagnoses of pharyngitis and tonsillitis into a QDM variable called $AcutePharyngitisOrTonsillitis to ensure the same Initial Population event pertains to all portions of the measure.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • Changed timing operator for URI diagnosis in Initial Population from 'ends after or concurrent with end of' to 'overlaps' to ensure inclusion of patients without an end date for their diagnosis.

    Measure Section: Initial Population

    Source of Change: Measure Lead

  • ​Updated logic by tying the diagnoses of pharyngitis and tonsillitis into a QDM variable called $AcutePharyngitisOrTonsillitis to ensure the same Initial Population event pertains to all portions of the measure.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Added a new line of logic to the Denominator Exclusions that requires the medication to be active at least one day prior to diagnosis of pharyngitis or tonsillitis to better meet the intent of the measure.

    Measure Section: Denominator Exclusions

    Source of Change: JIRA (CQM-496)

  • Added new lines of logic to the Denominator Exclusions for all NCQA-stewarded measures (except CMS82) to ensure patients in hospice care are excluded from the Denominator.

    Measure Section: Denominator Exclusions

    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 Acute Pharyngitis (2.16.840.1.113883.3.464.1003.102.12.1011): Deleted 1 SNOMEDCT code (55355000). Deleted 2 ICD9CM codes (034.0, 462).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Acute Tonsillitis (2.16.840.1.113883.3.464.1003.102.12.1012): Deleted 1 ICD9CM code (463). Added 1 SNOMEDCT code (10629271000119107).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Added 53 RXNORM codes and deleted 7 RXNORM codes (105152, 105170, 313251, 351239, 636559, 762666, 900424).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Encounter Inpatient (2.16.840.1.113883.3.666.5.307): Added Encounter Inpatient.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Hospice care ambulatory (2.16.840.1.113762.1.4.1108.15): Added Hospice care ambulatory.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Discharged to Health Care Facility for Hospice Care (2.16.840.1.113883.3.117.1.7.1.207): Added Discharged to Health Care Facility for Hospice Care.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Discharged to Home for Hospice Care (2.16.840.1.113883.3.117.1.7.1.209): Added Discharged to Home for Hospice Care.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Acute Tonsillitis (2.16.840.1.113883.3.464.1003.102.12.1012): Deleted 1 SNOMEDCT code (195667003).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Added 88 RXNORM codes and deleted 18 RXNORM codes.

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Group A Streptococcus Test (2.16.840.1.113883.3.464.1003.198.12.1012): Added 2 LOINC codes (17898-8, 78012-2).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Ambulatory/ED Visit (2.16.840.1.113883.3.464.1003.101.12.1061): Deleted 1 CPT code (99420).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

External Resources