#066: Appropriate Testing for Children with Pharyngitis

Quality ID

066

eMeasure ID

CMS146v6

High Priority Measure

Yes

Specifications

EHR Registry

Measure Type

Process

Specialty

Emergency Medicine Family Medicine Infectious Disease Pediatrics

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

 

Instructions

This measure is to be submitted once for each occurrence of pharyngitis during the performance period. Claims data will be analyzed to determine unique occurrences. This measure is intended to reflect the quality of services provided for the primary management of patients with pharyngitis who were dispensed an antibiotic. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

Measure Submission:

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.

 

Denominator

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 Instructions: To determine eligibility, look for any of the listed antibiotic drugs below in the 30 days prior to the visit with the pharyngitis diagnosis. As long as there are no prescriptions for the listed antibiotics during this time period, the patient is eligible for denominator inclusion.

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for registry-based measures.

Denominator Criteria (Eligible Cases):

Patients aged 3 to 18 years on date of encounter

AND

Diagnosis for pharyngitis (ICD-10-CM): J02.0, J02.8, J02.9, J03.00, J03.01, J03.80, J03.81, J03.90, J03.91

AND

Patient encounter during the performance period (CPT or HCPCS): 96160, 96161, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99241*, 99242*, 99243*, 99244*, 99245*, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, 99455, 99456, 99281, 99282, 99283, 99284, 99285, G0402

AND

Prescribed or dispensed antibiotic: G8711

AND NOT

DENOMINATOR EXCLUSIONS:

Patients who use hospice services any time during the measurement period: G9702 OR Children who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis: G9703

Table 1 - Antibiotic Medications

Description

Prescription

Aminopenicillins

Amoxicillin
Ampicillin

Beta-lactamase inhibitors

Ampicillin clavulanate 

First generation cephalosporins

Cefadroxil
Cephalexin
Cefazolin

Folate antagonist

Trimethoprim

Lincomycin derivatives

Clindamycin

Macrolides

Azithromycin
Erythromycin ethylsuccinate
Clarithromycin
Erythromycin lactobionate
Erythromycin
Erythromycin stearate

Miscellaneous antibiotics

Erythromycin-sulfisoxazole

Natural penicillins

Penicillin G potassium
Penicillin V potassium
Penicillin G sodium

Penicillinase-resistant penicillins

Dicloxacillin

Quinolones

Ciprofloxacin
Moxifloxacin
Levofloxacin
Ofloxacin

Second generation cephalosporins

Cefaclor
Cefuroxime
Cefprozil

Sulfonamides

Sulfamethoxazole-trimethoprim

Tetracyclines

Doxycycline
Tetracycline
Minocycline

Third generation cephalosporins

Cefdinir
Ceftibuten
Cefixime
Cefditoren
Cefpodoxime
Ceftriaxone

 

Numerator

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 Instructions: For performance, the measure will be calculated as the number of patient encounters where diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode over the total number of encounters in the denominator (patients aged 3 to 18 years with an outpatient or ED visit and an antibiotic ordered on or three days after the visit). A higher score indicates appropriate treatment of children with pharyngitis (e.g., the proportion for whom antibiotics were prescribed with an accompanying step test).

Numerator Options:

Performance Met: Group A Strep Test Performed (3210F)

OR

Performance Not Met: Group A Strep Test not Performed, reason not otherwise specified (3210F with 8P)

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