2023 # 116 Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis

CMS Measure ID: #116

Collection Type: CQM

Reporting Frequency: Every visit

Outcome: No

High Priority: Yes

NQS Domain: Efficiency and Cost Reduction

Measure Age: > 2 years

Instructions

This measure is to be submitted at each occurrence of acute bronchitis/bronchiolitis 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.

NOTE: Patient encounters for this measure conducted via telehealth (e.g., encounters coded with GQ, GT, 95, or POS 02 modifiers) are allowable.

Measure Submission Type:

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 for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.

Description

The percentage of episodes for patients ages 3 months and older with a diagnosis of acute bronchitis/bronchiolitis that did not result in an antibiotic dispensing event.

Denominator

All patients aged 3 months or older with an outpatient visit, telephone visit, e-visit or virtual check-in, observation visit or emergency department (ED) visit with a diagnosis of acute bronchitis/bronchiolitis during the measurement period

DENOMINATOR NOTE: Do not include visits that result in an inpatient admission. When a visit and an inpatient stay are billed on separate claims, the visit results in an inpatient stay when the visit date of service occurs on the day prior to the admission date or any time during the admission (admission date through discharge date). A 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 FeeSchedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Denominator Criteria (Eligible Cases):

Patients 3 months of age and older on date of encounter

AND

Diagnosis for acute bronchitis/bronchiolitis (ICD-10-CM): J20.3, J20.4, J20.5, J20.6, J20.7, J20.8, J20.9, J21.0, J21.1, J21.8, J21.9

AND

Patient encounter during the performance period (CPT or HCPCS): 98966, 98967, 98968, 98970, 98971, 98972, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99238, 99239, 99242*, 99243*, 99244*, 99245*, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 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*, 99421, 99422, 99423, 99429*, 99441, 99442, 99443, 99455, 99456, 99483, G0402, G0438, G0439, G0463*, T1015*

AND NOT

DENOMINATOR EXCLUSIONS:

Outpatient, ED or Observation visits that result in an inpatient admission: G2176

OR

Acute bronchitis/bronchiolitis episodes when the patient had a new or refill prescription of antibiotics (Table 1) in the 30 days prior to the episode date: G2177

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 (Table 1) 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/bronchiolitis over the total number of encounters in the denominator (patients aged 3 months and older with an outpatient, telephone, e-visit or virtual check-in, observation or ED visit for acute bronchitis/bronchiolitis). A higher score indicates appropriate treatment of patients with acute bronchitis/bronchiolitis (e.g., the proportion for whom antibiotics were not prescribed or dispensed on or three days after the encounter). Delayed prescriptions (where an antibiotic was prescribed and patient was instructed to delay taking the antibiotic) are considered “Performance Not Met”.

Table 1 – Antibiotic Medications
Note: This list should be used when assessing antibiotic prescriptions for the denominator exclusion and numerator components.

Numerator Options:

Performance Met:

Antibiotic neither prescribed nor dispensed (4124F)

OR

Performance Not Met:

Antibiotic prescribed or dispensed (4120F)