2025 MIPS Measure #116: Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis

Measure Description

The percentage of episodes for patients ages 3 months and older with a diagnosis of acute bronchitis/bronchiolitis that did not result in an antibiotic dispensing event.

Instructions

This measure is to be submitted at each occurrence of acute bronchitis/bronchiolitis 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.

NOTE: Patient encounters for this measure conducted via telehealth (including but not limited to encounters coded with GQ, GT, POS 02, POS 10) are allowable. Please note that effective January 1, 2025, while a measure may be denoted as telehealth eligible, specific denominator codes within the encounter may no longer be eligible due to changes outlined in the CY 2024 PFS Final Rule List of Medicare Telehealth Services.

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 3 months or older with an outpatient visit, emergency department (ED) visit, observation visit, telephone visit, e-visit or virtual check-in with a diagnosis of acute bronchitis/bronchiolitis during the measurement period

DENOMINATOR NOTE: Do not include visits that result in an inpatient admission. When a visit and an inpatient stay are billed on separate claims, the visit results in an inpatient stay when the visit date of service occurs on the day prior to the admission date or any time during the admission (admission date through discharge date). A 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 3 months of age and older on date of encounter

AND

Diagnosis for acute bronchitis/bronchiolitis (ICD-10-CM): J20.3, J20.4, J20.5, J20.6, J20.7, J20.8, J20.9, J21.0, J21.1, J21.8, J21.9

AND

Patient encounter during the performance period (CPT or HCPCS): 98000, 98001, 98002, 98003, 98004, 98005, 98006, 98007, 98008, 98009, 98010, 98011, 98012, 98013, 98014, 98015, 98016, 98966, 98967, 98968, 98970, 98971, 98972 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99238, 99239, 99242*, 99243*, 99244*, 99245*, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 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*, 99421, 99422, 99423, 99429*, 99455, 99456, 99457, 99483, G0071, G0402, G0438, G0439, G0463*, G2010, G2250, G2251, G2252, T1015*

WITHOUT

Place of Service (POS): 21

AND NOT

DENOMINATOR EXCLUSIONS:

Outpatient, ED or Observation visits that result in an inpatient admission: G2176

OR

Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (Table 1) in the 30 days prior to the episode date: G2177

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 (Table 1) 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/bronchiolitis over the total number of encounters in the denominator (patients aged 3 months and older with an outpatient, telephone, e-visit or virtual check-in, observation or ED visit for acute bronchitis/bronchiolitis). A higher score indicates appropriate treatment of patients with acute bronchitis/bronchiolitis (e.g., the proportion for whom antibiotics were not prescribed or dispensed on or three days after the encounter). Delayed prescriptions (where an antibiotic was prescribed and patient was instructed to delay taking the antibiotic) are considered “Performance Not Met”.

Table 1 – Antibiotic Medications

Note: This list should be used when assessing antibiotic prescriptions for the denominator exclusion and numerator components

Numerator Options:

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

OR

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

Rationale

Antibiotics are most often inappropriately prescribed for acute bronchitis (Gonzalez et al., 2001a). This measure assesses the percentage of episodes among members ages 3 months and older with a diagnosis of acute bronchitis/bronchiolitis that did not result in an antibiotic dispensing event.

Antibiotics are not indicated in clinical guidelines for treating with acute bronchitis who do not have a comorbidity or other infection for which antibiotics may be appropriate (Gonzalez et al., 2001b; Gonzalez et al., 2001c). Inappropriate antibiotic treatment of patients with acute bronchitis is of clinical concern, especially since misuse and overuse of antibiotics lead to antibiotic drug resistance (Steinman et al., 2004)). Acute bronchitis consistently ranks among the 10 conditions that account for most ambulatory office visits to U.S. physicians; furthermore, while the vast majority of acute bronchitis cases (more than 90%) have a nonbacterial cause, antibiotics are inappropriately prescribed 65%–80% of the time (Gonzalez et al., 2001a; McCaig et al., 2003).

Inappropriate antibiotic use can be addressed by reminding providers of clinical guideline recommendations and providing feedback about their prescribing behaviors. In addition, use of patient education interventions can discourage seeking antibiotics for viral conditions (such as the common cold), or without confirmatory tests such as group A strep test for pharyngitis.

References:

Gonzales, R., D.C. Malone, J.H. Maselli, M.A. Sande. 2001a. “Excessive Antibiotic Use for Acute Respiratory Infections in the United States.” Clinical Infectious Diseases 33:757–62.

Gonzales R., J.G. Bartlett, R.E. Besser, R.J. Cooper, J.M. Hickner, J.R. Hoffman, M.A. Sande. 2001b. “Principles of Appropriate Antibiotic Use for Treatment of Acute Respiratory Tract Infections in Adults: Background, Specific Aims, and Methods.” Ann Intern Med 134 (6): 479–86.

Gonzales R., J.G. Bartlett, R.E. Besser, J.M. Hickner, J.R. Hoffman, M.A. Sande, CDC. 2001c. “Principles of Appropriate Antibiotic Use for Treatment of Nonspecific Upper Respiratory Tract Infections in Adults: Background.” Ann Intern Med 134:490–4.

Steinman, M.A., A. Sauaia, J.H. Maselli, et al. 2004. “Office Evaluation and Treatment of Elderly Patients with Acute Bronchitis.” J Am Geriatr Soc 52:875–9.

McCaig, L.F., R.E. Besser, J.M. Hughes. 2003. “Antimicrobial Drug Prescription in Ambulatory Care Settings, United States, 1992–2000.” Emerg Infect Dis Apr; 9(4):432–7.

Clinical Recommendation Statements

Clinical guidelines do not support antibiotic treatment of otherwise healthy adults with acute bronchitis/bronchiolitis due to the viral origin of acute bronchitis/bronchiolitis. Patients with chronic bronchitis, COPD or other chronic comorbidity may be treated with antibiotics and are therefore excluded from the measure denominator (Gonzales et al., 2001).

Reference:

Gonzales, R., D.C. Malone, J.H. Maselli, M.A. Sande. 2001. “Excessive Antibiotic Use for Acute Respiratory Infections in the United States.” Clinical Infectious Diseases 33:757–62.