Thank you for your inquiry about CMS154v11: Appropriate Treatment for Upper Respiratory Infection (URI). Please see the responses to adding each code below. J02.0 - Strep throat/Strep pharyngitis: The measure intent is to include streptococcal pharyngitis as a competing diagnosis for CMS154 (URI). There is a code in the value set for "Streptococcal sore throat with scarlatina (disorder)" (SNOMED code 186357007) and therefore it is appropriate to map clinically equivalent diagnoses (e.g., J02.0 - Strep throat/Strep pharyngitis) to this code. If mapping is done, you should maintain documentation in case of a CMS audit. We will review the ICD10 codes and consider adding appropriate codes in the next possible measure publication (i.e., PY2025). H65.91 - Unspecified nonsuppurative otitis media, right ear: We do not include otitis “media” in the measure because oral antibiotics are not indicated for otitis media.

Patients with competing diagnoses that require antibiotic treatment are not being excluded from metric because diagnosis codes are not part of value set. This is resulting in lower performance. Consider including these diagnoses as part of the value set to exclude these patients with antibotic treatment for competing diagnoses.