CMS 146v10: Appropriate Testing for Pharyngitis

Measure: The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic dispensing event and a group A streptococcus (strep) test
Measure Type High Priority Measure Scoring
Process Yes A higher percentage indicates better quality
Denominator Outpatient, telephone, online assessment (i.e. e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis and an antibiotic dispensing event on or within 3 days after the episode date among patients 3 years or older
Numerator A group A streptococcus test in the 7-day period from 3 days prior to the episode date through 3 days after the episode date
Denominator Exceptions None
Denominator Exclusions

Exclude:

  • Episodes where the patient is taking antibiotics in the 30 days prior to the episode date, or had an active prescription on the episode date

  • Episodes where the patient had a comorbid condition during the 12 months prior to or on the episode date

  • Episodes when the patient had hospice care for any part of the measurement period

  • Episodes where the patient had a competing diagnosis on or within three days after the episode date

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 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

    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, 98966, 98967, 98968, 99441, 99442, 99443, 98969, 98970, 98971, 98972, 99421, 99422, 99423, 99458

HCPCS: G0071, G2010, G2012, G2061, G2062, G2063

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 after the qualifying encounter date
  • Has an encounter with a comorbid condition during the 12 months prior to or on the qualifying encounter date
  • Is in hospice care for any part of 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.

For 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, 98966, 98967, 98968, 99441, 99442, 99443, 98969, 98970, 98971, 98972, 99421, 99422, 99423, 99458

HCPCS: G0071, G2010, G2012, G2061, G2062, G2063

A patient with an active diagnosis for a comorbid condition—assessed on the day of the denominator-eligible encounter or in the 12 months prior—will be excluded from this measure.

For this measure, a comorbid condition is a diagnosis different from the denominator-eligible diagnosis for which it is appropriate to prescribe an antibiotic. Examples of a comorbid condition include tuberculosis and atelectasis.

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for comorbid 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, 98966, 98967, 98968, 99441, 99442, 99443, 98969, 98970, 98971, 98972, 99421, 99422, 99423, 99458

HCPCS: G0071, G2010, G2012, G2061, G2062, G2063

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/2022/cms146v10

 

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