[CQM-6074] CMS 154-Appropriate Treatment for Upper Respiratory Infection (Denominator Exclusions) Created: 05/03/23 Updated: 02/06/24 Resolved: 05/24/23 |
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| Status: | Closed |
| Project: | eCQM Issue Tracker |
| Component/s: | None |
| Type: | EC eCQMs - Eligible Clinicians | Priority: | Moderate |
| Reporter: | Moyna P Temple | Assignee: | Mathematica EC eCQM Team (Inactive) |
| Resolution: | Answered | Votes: | 1 |
| Labels: | None | ||
| Solution: | Thank you for your question regarding CMS154v11, Appropriate Treatment for Upper Respiratory Infection. 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). H60.91 - Recurrent otitis externa of right ear: We do not include otitis “externa” in the measure because oral antibiotics are not indicated for otitis externa. Z20.818 - Exposure to Streptococcal pharyngitis: This code is not included because we do not believe that antibiotics are warranted for “exposure” to diseases. They are only warranted if person actually is positive for the disease (e.g., tests positive for strep). |
| Solution Posted On: | |
| 2024 Performance Period EC eCQMs: |
CMS0154v12
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| 2023 Performance Period EC eCQMs: |
CMS0154v11
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| Impact: | In the past, the codes for strep throat and ear infections were included in the list of competing diagnoses or denominator exclusions when they were linked to an antibiotic order within three days of the URI diagnosis. Additional DENOMINATOR EXCLUSIONS when a patient prescribed or dispensed antibiotic for a documented medical reason(s) within three days included: Intestinal infection, pertussis, bacterial infection, Lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease [syphilis, chlamydia, inflammatory diseases (female reproductive organs)], infections of the kidney, cystitis or UTI, and acne. |
| Description |
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Regarding: CMS 154-Appropriate Treatment for Upper Respiratory Infection. |
| Comments |
| Comment by Mathematica EC eCQM Team (Inactive) [ 05/18/23 ] |
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We apologize for the delay in providing a response for your question. We continue to investigate the issue noted in your ticket and will provide a response as soon as we are able. Thank you for your continued patience. |
| Comment by Mathematica EC eCQM Team (Inactive) [ 05/11/23 ] |
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We continue to investigate the issue noted in your ticket and will provide a response as soon as we are able. Thank you for your patience. |
| Comment by Mathematica EC eCQM Team (Inactive) [ 05/04/23 ] |
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Thank you for submitting your question. We will review your ticket and provide a response as soon as possible. |