CMS 146v6: Appropriate Testing for Children with Pharyngitis

Measure: Percentage of children 3-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode
Measure Type High Priority Measure Scoring
Process Yes A higher percentage indicates better quality
Denominator Children 3-18 years of age who had an outpatient or emergency department (ED) visit with a diagnosis of pharyngitis during the measurement period and an antibiotic ordered on or three days after the visit
Numerator Children with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitis
Denominator Exceptions None
Denominator Exclusions

Children who:

  • Are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis
  • Were in hospice care during the measurement year

This eCQM requires a lab interface to be met. Customers interested in a lab interface should contact Sevocity Support to begin the process of a new interface setup. Interface setup requirements and fees vary per request.

Patients who meet the following criteria will be included in the denominator:

  • Age must be ≥ 3 years and < 18 years at the beginning of the Measurement Period

    AND

  • Must have an active diagnosis of pharyngitis or tonsillitis during the Measurement Period

    AND

  • Must have at least one encounter during the Measurement Period finalized by the EC/EP

    AND

  • Must have an antibiotic prescribed on the day of their encounter or in the 3 days after the encounter

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99241, 99242, 99243, 99244, 99245, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99455, 99456

The patient must have an active diagnosis of pharyngitis or tonsillitis during the Measurement Period. Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for pharyngitis and tonsillitis can be located here.

To prescribe a medication, go to Encounter > Medications > Manage/Prescribe Meds > Prescribe a Medication. A comprehensive list of eligible antibiotic medications for pharyngitis can be located here.

A patient will be counted as an exclusion if:

• They were prescribed an antibiotic in the 30 days before they were diagnosed with pharyngitis or tonsillitis

• Were in hospice care during the measurement year

To document hospice care services as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

SNOMED CT: 385763009, 385765002

Order Status must be marked as Complete.

SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab.

A patient will be counted in the numerator if they received a group A strep test 3 days before their encounter, on the day of their encounter, or 3 days after their encounter.

A positive result for group A strep must be stored as an e-Lab result in the patient chart to count toward the numerator.

  1. From the Clinic Inbox, select the lab result to be stored and click View
  2. Click Select to search for and select a patient
  3. Verify patient displayed matches the lab result and select the I have verified the following lab results belong to the above patient checkbox
  4. Click Sign/Route
  5. Select the Sign checkbox and click OK

Stored e-Lab results can be viewed in the Flowsheets/Labs > Scanned/E-Labs tab of the patient chart.

https://ecqi.healthit.gov/ecqm/ep/2018/cms146v6

 

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