#116: Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis

Quality ID

116

NQF

0058

High Priority Measure

Yes

Specifications

Registry

Measure Type

Process

Specialty

Emergency Medicine Family Medicine Internal Medicine Preventive Medicine Urgent Care

Measure Description

The percentage of adults 18–64 years of age with a diagnosis of acute bronchitis who were not prescribed or dispensed an antibiotic prescription

 

Instructions

This measure is to be submitted at each occurrence of acute bronchitis during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

 

Denominator

All patients aged 18 through 64 years of age with an outpatient, observation or emergency department (ED) visit with a diagnosis of acute bronchitis during the measurement period

DENOMINATOR NOTE: To determine eligibility, look for any of the listed antibiotic drugs below in the 30 days prior to the visit with the acute bronchitis diagnosis. As long as there are no prescriptions for the listed antibiotics during this time period, the patient is eligible for denominator inclusion. Do not include observation or ED visits that result in an inpatient admission. When an ED or observation visit and an inpatient stay are billed on separate claims, the visit results in an inpatient stay when the admission date for the inpatient stay occurs on the ED/observation date of service or one calendar day after. An ED or observation visit billed on the same claim as an inpatient stay is considered a visit that resulted in an inpatient stay.

*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 MIPS CQMs.

Denominator Criteria (Eligible Cases):

Patients 18 through 64 years of age on date of encounter

AND

Diagnosis for acute bronchitis (ICD-10-CM): J20.3, J20.4, J20.5, J20.6, J20.7, J20.8, J20.9

AND

Patient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403,99404, 99411, 99412, 99420, 99429 ,99455, 99456, G0402, G0438, G0439, G0463*, T1015*

AND NOT DENOMINATOR EXCLUSIONS:

Observation or ED visits that result in an inpatient admission

OR

Documentation of medical reason(s) for prescribing or dispensing antibiotic (e.g., intestinal infection, pertussis, bacterial infection, Lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis/ mastoiditis/bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia, gonococcal infections/venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis/UTI, acne, HIV disease/asymptomatic HIV, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic bronchitis, emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease due to external agents, other diseases of the respiratory system, and tuberculosis: G9712

OR

Patients who use hospice services any time during the measurement period: G9713

 

Numerator

Patients who were not prescribed or dispensed antibiotics on or within 3 days of the initial date of service

Numerator Instructions:

For performance, the measure will be calculated as the number of patient encounters where antibiotics were neither prescribed nor dispensed on or within 3 days of the episode for acute bronchitis over the total number of encounters in the denominator (patients aged 18 through 64 years with an outpatient, observation or ED visit for acute bronchitis). A higher score indicates appropriate treatment of patients with acute bronchitis (e.g., the proportion for whom antibiotics were not prescribed or dispensed on or three days after the encounter).

Antibiotic Medications

Description

Prescription

 

Aminoglycosides

Amikacin
Tobramycin
Gentamicin

Streptomycin

Aminopenicillins

Amoxicillin

Ampicillin

Antipseudomonal penicillins

 

 

Beta-lactamase inhibitors

Amoxicillin-clavulanate
Ampicillin- sulbactam 

Piperacillin-tazobactam
Ticarcillin-clavulanate

First-generation cephalosporins

Cefadroxil
Cephalexin

Cefazolin

Fourth-generation cephalosporins

Cefepime

 

Ketolides

Telithromycin

 

Lincomycin derivatives

Clindamycin
Lincomycin

 

Macrolides

Azithromycin
Clarithromycin
Erythromycin stearate

Erythromycin
Erythromycin ethylsuccinate
Erythromycin lactobionate

Miscellaneous antibiotics

Aztreonam
Chloramphenicol
Vancomycin
Dalfopristin-quinupristin
Linezolid

Daptomycin
Metronidazole
Erythromycin-sulfisoxazole

Natural penicillins

Penicillin G sodium benzathineprocaine
Penicillin G potassium
Penicillin G procaine

Penicillin V potassium
Penicillin G benzathine 

Penicillinase resistant penicillins

Dicloxacillin
Oxacillin

Nafcillin

Quinolones

Ciprofloxacin
Gemifloxacin
Ofloxacin

Levofloxacin
Moxifloxacin
Norfloxacin
Moxifloxacin

Rifamycin derivatives

Rifampin

 

Second generation cephalosporin

Cefaclor
Cefotetan
Cefprozil

Cefoxitin
Cefuroxime

Sulfonamides

Sulfadiazine

Sulfamethoxazole-trimethoprim

Tetracyclines

Doxycycline
Tetracycline

Minocycline

Third generation cephalosporins

Cefdinir
Cefditoren
Cefpodoxime
Cefixim

Cefotaxime
Ceftibuten
Ceftriaxone
Ceftazidime

Urinary anti-infectives

Fosfomycin
Nitrofurantoin macrocrystals
Trimethoprim

Nitrofuantoin
Nitrofurantoin macrocrystalsmonohydrate 

Numerator Options:

Performance Met: Antibiotic neither prescribed nor dispensed (4124F)

OR

Performance Not Met: Antibiotic prescribed or dispensed (4120F)

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