Appropriate Testing for Children with Pharyngitis

Last updated: June 9, 2017

CMS Measure ID: CMS146v5
Version: 5
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

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
Next Version: Appropriate Testing for Children with Pharyngitis
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

Quality ID: 66
High Priority Measure: Yes
Data Submission Method: EHR,Registry
Specialty Measure Set: Emergency Medicine,General Practice/Family Medicine,Pediatrics

Specifications

Release Notes

Header

  • Updated Clinical Recommendation Statement.

    Section: Clinical Recommendation Statement

    Source: Measure Lead

  • ​Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Updated lower age range from age 2 to age 3 to align with IDSA/AHA guidelines.

    Section: Description

    Source: Measure Lead

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Removed Endorsement.

    Section: Endorsed By

    Source: Measure Lead

  • Updated lower age range from age 2 to age 3 to align with IDSA/AHA guidelines.

    Section: Initial Population

    Source: Measure Lead

  • Removed Endorsement Number.

    Section: NQF Number

    Source: Measure Lead

  • Updated Rationale.

    Section: Rationale

    Source: Measure Lead

  • Updated References.

    Section: Reference

    Source: Measure Lead

Logic

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Denominator Exclusions

    Source: QDM Standards

  • Updated the Denominator Exclusion to ensure patients on antibiotics for more than 30 days prior to the Occurrence A Diagnosis are excluded.

    Section: Denominator Exclusions

    Source: JIRA (CQM-1570)

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Initial Population

    Source: QDM Standards

  • Updated lower age range from age 2 to age 3 to align with IDSA/AHA guidelines.

    Section: Initial Population

    Source: Measure Lead

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

Value Set

  • Value set Acute Pharyngitis (2.16.840.1.113883.3.464.1003.102.12.1011): Added 1 ICD10CM code (J02.8).

    Section: None

    Source: None

  • Value set Ambulatory/ED Visit (2.16.840.1.113883.3.464.1003.101.12.1061): Added 25 CPT codes.

    Section: None

    Source: None

  • Value set Antibiotic Medications for Pharyngitis (2.16.840.1.113883.3.464.1003.196.12.1001): Deleted 73 RXNORM codes.

    Section: None

    Source: None

  • Value set Group A Streptococcus Test (2.16.840.1.113883.3.464.1003.198.12.1012): Deleted 1 LOINC code (6556-5).

    Section: None

    Source: None

External Resources