Brief Description of Measure: CMS154: Appropriate Treatment for Upper Respiratory Infection (URI) 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 order Description of Issue: The measure intent is to include acute pharyngitis/tonsillitis (e.g., J02.0) as a competing diagnosis for CMS154 (Appropriate Treatment for Upper Respiratory Infection (URI)). However, CMS146 (Appropriate Testing for Pharyngitis) and CMS154 (Appropriate Treatment for Upper Respiratory Infection (URI)) use the same "Competing Conditions for Respiratory Conditions" (2.16.840.1.113883.3.464.1003.102.12.1017) value set and thus these codes cannot be added to the current value set without excluding those conditions from the denominator of CMS146 (Appropriate Testing for Pharyngitis). As a result, we will add two value sets to the exclusion criteria for CMS154 to meet measure intent. This issue does not impact CMS146.

Proposed Solution: Add appropriate codes using separate, existing value sets. Add value sets: valueset "Acute Pharyngitis": (OID: 2.16.840.1.113883.3.464.1003.102.12.1011) valueset "Acute Tonsillitis": (OID: 2.16.840.1.113883.3.464.1003.102.12.1012) //before: Encounter with Competing Diagnosis for Upper Respiratory Infection  ( "Encounter with Upper Respiratory Infection" EncounterWithURI    with ["Diagnosis": "Competing Conditions for Respiratory Conditions"] CompetingCondition      such that CompetingCondition.prevalencePeriod starts 3 days or less on or after day of start of EncounterWithURI.relevantPeriod    return EncounterWithURI //after: Encounter with Competing Diagnosis for Upper Respiratory Infection ( "Encounter with Upper Respiratory Infection" EncounterWithURI      with ( ["Diagnosis": "Competing Conditions for Respiratory Conditions"]  Union [“Diagnosis”: “Acute Pharyngitis”]  Union [“Diagnosis”: “Acute Tonsillitis “] ) CompetingDiagnosis        such that CompetingDiagnosis.prevalencePeriod starts 3 days or less on or after day of start of EncounterWithURI.relevantPeriod      return EncounterWithURI  ) Rationale for Change: Adding Acute Pharyngitis and Acute Tonsillitis value sets to the competing diagnosis exclusion in CMS154 will meet measure intent and allow for increased specificity while retaining harmonized value sets to the extent possible.