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2023 eCQM Measure 154 Appropriate Treatment for Upper Respiratory Infection (URI)

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    • Kimberly Davis
    • 623-340-5882
    • Banner Health
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      Thank you for your inquiry about CMS154v11, Appropriate Treatment for Upper Respiratory Infection (URI), regarding inclusion of Strep throat/Strep pharyngitis (ICD10 code J02.0) as a competing condition. The measure intent is to include streptococcal pharyngitis as a competing diagnosis for CMS154. There is a code in the value set for "Streptococcal sore throat with scarlatina (disorder)" (SNOMED code 186357007). 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).
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      Thank you for your inquiry about CMS154v11, Appropriate Treatment for Upper Respiratory Infection (URI), regarding inclusion of Strep throat/Strep pharyngitis (ICD10 code J02.0) as a competing condition. The measure intent is to include streptococcal pharyngitis as a competing diagnosis for CMS154. There is a code in the value set for "Streptococcal sore throat with scarlatina (disorder)" (SNOMED code 186357007). 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).
    • CMS0154v11
    • All patients with Not Met, Antibiotic Ordered outcome can be Denominator Exclusion with accepted Competing Condition code J02.0 Streptococcal Pharyngitis.

      Patient with URI Dx (J06.9) on 6/9/2023 along with a Streptococcal Pharyngitis Dx (J02.0) on 6/11/23.  The pt received antibiotic order of Amoxicillin ordered on 6/11/23 - less than 3 days after the start of the qualifying encounter with the URI Dx on 6/9/23.  

      One would expect antibiotics to be given for a Streptococcal Pharyngitis Dx (J02.0) thus, making the Strep Pharyngitis a Competing Condition.  

      Please explain why the Streptococcal Pharyngitis Dx (J02.0) is not found on the Value Set?  

            edave Mathematica EC eCQM Team
            kimberly.davis2 Kimberly Davis
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