2023 # 331 Adult Sinusitis: Antibiotic Prescribed for Acute Viral Sinusitis (Overuse)

CMS Measure ID: #331

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 may be submitted based on the actions of the submitting eligible clinician who performs the quality action, described in the measure, based on services provided within measure-specific denominator coding. This measure is to be submitted once for each occurrence for patients with acute viral sinusitis during the performance period.

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

Percentage of patients, aged 18 years and older, with a diagnosis of acute viral sinusitis who were prescribed an antibiotic within 10 days after onset of symptoms

2023 Benchmarks (from 2021 CMS data)

Registry

Topped out: No
Capped at 7: No

Decile 0: 96.33 – 100
Decile 1: 81.09 – 96.32
Minimum: 64.66 – 81.08
Decile 3: 46.96 – 64.65
Decile 4: 32.12 – 46.95
Decile 5: 17.74 – 32.11
Decile 6: 8.01 – 17.73
Decile 7: 3.77 – 8
Decile 8: 0.4 – 3.76
Decile 9: 0.01 – 0.39
Decile 10: 0 – 0

Denominator

All patients aged 18 years and older with a diagnosis of acute viral sinusitis

Definition:

Acute Sinusitis/Rhinosinusitis– Up to 4 weeks of purulent nasal drainage (anterior, posterior, or both) accompanied by nasal obstruction, facial pain-pressure-fullness, or both:

Purulent nasal discharge is cloudy or colored, in contrast to the clear secretions that typically accompany viral upper respiratory infection and may be reported by the patient or observed on physical examination. Nasal obstruction may be reported by the patient as nasal obstruction, congestion, blockage, or stuffiness, or may be diagnosed by physical examination
Facial pain-pressure-fullness may involve the anterior face, periorbital region, or manifest with headache that is localized or diffuse

Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years on date of encounter

AND

Diagnosis for acute sinusitis (ICD-10-CM): J01.00, J01.01, J01.10, J01.11, J01.20, J01.21, J01.30,J01.31, J01.40, J01.41, J01.80, J01.81, J01.90, J01.91

AND

Patient encounter during performance period (CPT): 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99424, 99491

Numerator

Patients prescribed any antibiotic within 10 days after onset of symptoms

Numerator Instructions:

INVERSE MEASURE – A lower calculated performance rate for this measure indicates better clinical care or control. The “Performance Not Met” numerator option for this measure is the representation of the better clinical quality or control. Submitting that numerator option will produce a performance rate that trends closer to 0%, as quality increases. For inverse measures, a rate of 100% means all of the denominator eligible patients did not receive the appropriate care or were not in proper control.

Numerator Options:

Performance Met:

Antibiotic regimen prescribed within 10 days after onset of symptoms (G9286)

Denominator Exception:

Antibiotic regimen prescribed within 10 days after onset of symptoms for documented medical reason (G9505)

Performance Not Met:

Antibiotic regimen not prescribed within 10 days after onset of symptoms (G9287)