CMS 146v8: 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 TypeHigh Priority MeasureScoring
ProcessYesA higher percentage indicates better quality
DenominatorChildren 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
NumeratorChildren with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitis
Denominator ExceptionsNone
Denominator Exclusions
  • Children who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitis
  • Children who had an encounter with a competing diagnosis within three days after the initial diagnosis of pharyngitis
  • Children whose hospice care overlaps the measurement period.

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 is ≥ 3 years and < 18 years at the beginning of the Measurement Period

    AND

  • Have at least one eligible encounter with an active diagnosis of pharyngitis or tonsillitis during the Measurement Period finalized by the EC/EP

    AND

  • Have an antibiotic prescribed on the day of the eligible 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

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis codes for pharyngitis and tonsillitis are:

Acute Pharyngitis

ICD-10: J02.0, J02.8, J02.9

Acute Tonsillitis

ICD-10: J03.00, J03.01, J03.80, J03.81, J03.90, J03.91

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

A patient will be excluded from this measure if they meet any of the following conditions:

  • Was prescribed an antibiotic in the 30 days before they were diagnosed with pharyngitis or tonsillitis
  • Has an encounter with an active diagnosis for a competing condition within three days of the initial pharyngitis diagnosis
  • Is in hospice care during the Measurement Period

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

A patient with an active diagnosis for a competing condition—assessed in the three days after the denominator-eligible encounter—will be excluded from this measure.

A competing condition is a diagnosis different from the denominator-eligible diagnosis for which it is appropriate to prescribe an antibiotic. Examples of a competing condition include otitis media, sinusitis, and pneumonia.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for competing conditions can be located here.

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

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 Pending or 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 with result in the 3 days before their eligible encounter, on the day of their eligible encounter, or in the 3 days after their eligible encounter.

To document that a group A strep was performed, an e-Lab result for the test must be stored in the patient chart.

  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/2020/cms146v8

 

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