CMS 154 - Appropriate Treatment for Children with Upper Respiratory Infection (URI)

Overview

CMS154v8 (2020)
CMS154v9 (2021)
CMS154v10 (2022)

Identifiers

CMS eCQM ID	NQF eCQM ID	NQF	MIPS Quality ID
CMS154v10	–	0069	065

*MIE only supports data collection and reporting using eCQM specifications

Definitions

Description	Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event.
Initial Patient Population	Outpatient visits, telephone visits, online assessments (i.e. e-visit or virtual check-in), observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older.
Denominator	Equals Initial Population
Denominator Exclusions	Exclude URI episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude URI episodes when the patient had an active prescription of antibiotics in the 30 days prior to the episode date, including the episode date up until the time of the encounter. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Exclude URI episodes when the patient had hospice care for any part of the measurement period.
Numerator	URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department visit for an upper respiratory infection
Numerator Exclusions	–
Denominator Exceptions	–

Additional Information

Measure Type	Process measure
Measure Scoring	Proportion measure
Stratification	3 months-17 years 18-64 years 65 years and older
Granularity	Encounter
Improvement Notation	Higher score indicates better quality
Domain	Efficiency and Cost Reduction

Clinical Instructions

New UI Visit Encounter (valid RC202109+)

Original Visit Encounter

Clinical Instructions

Tracks children aged 13 months to 18 years who have been diagnosed with an upper respiratory infection, and were not dispensed an antibiotic on or 3 days after the visit for the infection.

1. Ensure patient has a diagnosis of Upper Respiratory Infection.
2. For individuals who have been diagnosed, review medications and ensure an antibiotic was not dispensed on or 3 days after the visit for the infection.

Evidence

Initial Patient Population

Name	Value Set
Diagnosis: Upper Respiratory Infection	2.16.840.1.113883.3.464.1003.102.12.1022
Encounter, Performed: Emergency Department Visit	2.16.840.1.113883.3.464.1003.101.12.1010
Encounter, Performed: Home Healthcare Services	2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed: Hospital Observation Care - Initial	2.16.840.1.113883.3.464.1003.101.12.1002
Encounter, Performed: Medical Disability Exam	2.16.840.1.113883.3.464.1003.101.12.1073
Encounter, Performed: Observation	2.16.840.1.113883.3.464.1003.101.12.1086
Encounter, Performed: Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital observation status if the discharge is on other than the initial date of observation status. To report services to a patient designated as observation status or inpatient status and discharged on the same date, use the codes for Observation or Inpatient Care Services [including Admission and Discharge Services, 99234-99236 as appropriate.])	CPT Code 99217
Encounter, Performed: Office Visit	2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed: Online Assessments	2.16.840.1.113883.3.464.1003.101.12.1089
Encounter, Performed: Outpatient Consultation	2.16.840.1.113883.3.464.1003.101.12.1008
Encounter, Performed: Preventive Care Services - Established Office Visit, 18 and Up	2.16.840.1.113883.3.464.1003.101.12.1025
Encounter, Performed: Preventive Care Services - Group Counseling	2.16.840.1.113883.3.464.1003.101.12.1027
Encounter, Performed: Preventive Care Services - Other	2.16.840.1.113883.3.464.1003.101.12.1030
Encounter, Performed: Preventive Care Services, Initial Office Visit, 0 to 17	2.16.840.1.113883.3.464.1003.101.12.1022
Encounter, Performed: Preventive Care Services-Individual Counseling	2.16.840.1.113883.3.464.1003.101.12.1026
Encounter, Performed: Preventive Care Services-Initial Office Visit, 18 and Up	2.16.840.1.113883.3.464.1003.101.12.1023
Encounter, Performed: Preventive Care, Established Office Visit, 0 to 17	2.16.840.1.113883.3.464.1003.101.12.1024
Encounter, Performed: Telephone Visits	2.16.840.1.113883.3.464.1003.101.12.1080

Denominator Exclusions

Name	Value Set
Diagnosis: Comorbid Conditions for Respiratory Conditions	2.16.840.1.113883.3.464.1003.102.12.1025
Diagnosis: Competing Conditions for Respiratory Conditions	2.16.840.1.113883.3.464.1003.102.12.1017
Encounter, Performed: Encounter Inpatient	2.16.840.1.113883.3.666.5.307
Intervention, Order: Hospice care ambulatory	2.16.840.1.113762.1.4.1108.15
Intervention, Performed: Hospice care ambulatory	2.16.840.1.113762.1.4.1108.15

Numerator

Name	Value Set
Medication, Active: Antibiotic Medications for Pharyngitis	2.16.840.1.113883.3.464.1003.196.12.1001
Medication, Order: Antibiotic Medications for Pharyngitis	2.16.840.1.113883.3.464.1003.196.12.1001

Source(s)

eCQI CMS154