2019 MIPS Measure #116: Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis

Measure Type High Priority Measure? Collection Type(s)
Process yes MIPS CQM

Measure Description

The percentage of adults 18–64 years of age with a diagnosis of acute bronchitis who were not prescribed or dispensed an antibiotic prescription

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Instructions

This measure is to be submitted at each occurrence of acute bronchitis during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

Measure Submission Type:

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

Denominator

All patients aged 18 through 64 years of age with an outpatient, observation or emergency department (ED) visit with a diagnosis of acute bronchitis during the measurement period

DENOMINATOR NOTE: To determine eligibility, look for any of the listed antibiotic drugs below in the 30 days prior to the visit with the acute bronchitis diagnosis. As long as there are no prescriptions for the listed antibiotics during this time period, the patient is eligible for denominator inclusion. Do not include observation or ED visits that result in an inpatient admission. When an ED or observation visit and an inpatient stay are billed on separate claims, the visit results in an inpatient stay when the admission date for the inpatient stay occurs on the ED/observation date of service or one calendar day after. An ED or observation visit billed on the same claim as an inpatient stay is considered a visit that resulted in an inpatient stay.

*Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Denominator Criteria (Eligible Cases):

Patients 18 through 64 years of age on date of encounter

AND

Diagnosis for acute bronchitis (ICD-10-CM): J20.3, J20.4, J20.5, J20.6, J20.7, J20.8, J20.9

AND

Patient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 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, 99420, 99429 ,99455, 99456, G0402, G0438, G0439, G0463*, T1015*

AND NOT

DENOMINATOR EXCLUSIONS:

Observation or ED visits that result in an inpatient admission

OR

Documentation of medical reason(s) for prescribing or dispensing antibiotic (e.g., 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/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/UTI, acne, HIV disease/asymptomatic HIV, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic bronchitis, emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease due to external agents, other diseases of the respiratory system, and tuberculosis: G9712

OR

Patients who use hospice services any time during the measurement period: G9713

Numerator

Patients who were not prescribed or dispensed antibiotics on or within 3 days of the initial date of service

Numerator Instructions:

For performance, the measure will be calculated as the number of patient encounters where antibiotics were neither prescribed nor dispensed on or within 3 days of the episode for acute bronchitis over the total number of encounters in the denominator (patients aged 18 through 64 years with an outpatient, observation or ED visit for acute bronchitis). A higher score indicates appropriate treatment of patients with acute bronchitis (e.g., the proportion for whom antibiotics were not prescribed or dispensed on or three days after the encounter).

Antibiotic Medications

Description Prescription
Aminoglycosides Amikacin

Tobramycin

Gentamicin

Streptomycin

Aminopenicillins Amoxicillin

Ampicillin

Antipseudomonal penicillins
Beta-lactamase inhibitors Amoxicillin-clavulanate

Ampicillin- sulbactam

Piperacillin-tazobactam

Ticarcillin-clavulanate

First-generation cephalosporins Cefadroxil

Cephalexin

Cefazolin

Fourth-generation cephalosporins Cefepime
Ketolides Telithromycin
Lincomycin derivatives Clindamycin Lincomycin
Macrolides Azithromycin

Clarithromycin

Erythromycin stearate

Erythromycin

Erythromycin ethylsuccinate

Erythromycin lactobionate

Miscellaneous antibiotics Aztreonam

Chloramphenicol

Vancomycin

Dalfopristin-quinupristin

Linezolid

Daptomycin Metronidazole

Erythromycin-sulfisoxazole

Natural penicillins Penicillin G sodium benzathine- procaine

Penicillin G potassium

Penicillin G procaine

Penicillin V potassium

Penicillin G benzathine

Penicillinase resistant penicillins Dicloxacillin

Oxacillin

Nafcillin

Quinolones Ciprofloxacin

Gemifloxacin

Ofloxacin

Levofloxacin

Moxifloxacin

Norfloxacin

Moxifloxacin

Rifamycin derivatives Rifampin
Second generation cephalosporin Cefaclor

Cefotetan

Cefprozil

Cefoxitin

Cefuroxime

Sulfonamides Sulfadiazine

Sulfamethoxazole-trimethoprim

Tetracyclines Doxycycline

Tetracycline

Minocycline

Third generation cephalosporins Cefdinir

Cefditoren

Cefpodoxime

Cefixim

Cefotaxime

Ceftibuten

Ceftriaxone

Ceftazidime

Urinary anti-infectives Fosfomycin

Nitrofurantoin macrocrystals

Trimethoprim

Nitrofurantoin

Nitrofurantoin macrocrystals- monohydrate

Numerator Options:

Performance Met: Antibiotic neither prescribed nor dispensed (4124F)

OR

Performance Not Met: Antibiotic prescribed or dispensed (4120F)


Tags

CMS-Emergency-Medicine-2019, CMS-Family-Medicine-2019, CMS-Internal-Medicine-2019, CMS-Preventive-Medicine-2019, CMS-Urgent-Care-2019, Emergency Medicine, ENT/Otolaryngology, General Practice/Family Medicine, Geriatrics / Gerontology, Hospitalists, Internal Medicine, Palliative Care, Preventive Medicine, Pulmonary Medicine, Quality-2019, Sleep Medicine