CMS146: Appropriate Testing for Pharyngitis. Metric definition states this eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order from January 1 to December 28 of the measurement period.

We have examples of patients who had two eligible outpatient encounters on the same day with two different providers (different TINs). The patients are being included in the metric denominator for both eligible encounters, even though only one encounter includes the pharyngitis/tonsillitis encounter diagnosis and antibiotic (and strep test if meeting).

First patient example: First encounter had diagnosis of Sore throat J02.9 (included in pharyngitis/tonsillitis encounter diagnosis) with antibiotic prescription (Amoxicillin 1,040mg oral daily), and a completed strep test - meeting as expected. The second encounter of the same day (different TIN/provider) had no pharyngitis/tonsillitis encounter diagnosis or antibiotic prescription, but was included in the metric denominator also as meeting.

Another patient example: First encounter with otolaryngology (no encounter diagnosis included in pharyngitis/tonsillitis value set or antibiotic prescribed) patient 'not meeting' metric. Second encounter of the same day with primary care - has encounter diagnosis of Sore throat J02.9 (included in pharyngitis/tonsillitis value set) and antibiotic prescribed with no strep test performed ('not meeting' as expected).