2023 # 332 Adult Sinusitis: Appropriate Choice of Antibiotic: Amoxicillin With or Without Clavulanate Prescribed for Patients with Acute Bacterial Sinusitis (Appropriate Use)

CMS Measure ID: #332

Collection Type: CQM

Reporting Frequency: Once per patient per year

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 a minimum of once per performance period for patients with acute bacterial 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 bacterial sinusitis that were prescribed amoxicillin, with or without clavulanate, as a first line antibiotic at the time of diagnosis

2023 Benchmarks (from 2021 CMS data)

Registry

Topped out: No
Capped at 7: No

Decile 0: 0 – 9.99
Decile 1: 10 – 59.37
Minimum: 59.38 – 66.66
Decile 3: 66.67 – 74.99
Decile 4: 75 – 80.55
Decile 5: 80.56 – 84.46
Decile 6: 84.47 – 88.88
Decile 7: 88.89 – 93.17
Decile 8: 93.18 – 96.96
Decile 9: 96.97 – 99.99
Decile 10: 100 – 100

Denominator

All patients aged 18 years and older with a diagnosis of acute bacterial sinusitis who are prescribed an antibiotic

Definition:

Acute Bacterial Rhinosinusitis (ABRS) – Acute rhinosinusitis that is caused by, or is presumed to be caused by, bacterial infection. A clinician should diagnose ABRS when: (a) symptoms or signs of acute rhinosinusitis are present 10 days or more beyond the onset of upper respiratory symptoms, or (b) symptoms or signs of acute rhinosinusitis worsen within 10 days after an initial improvement (double worsening)

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

Diagnosis for bacterial and infectious agents (ICD-10-CM): B95.0, B95.1, B95.2, B95.3, B95.4, B95.5, B95.61, B95.62, B95.7, B95.8, B96.0, B96.1, B96.20, B96.21, B96.22, B96.23, B96.29, B96.3, B96.4, B96.5, B96.6, B96.7, B96.81, B96.82, B96.89

Sinusitis caused by, or presumed to be caused by, bacterial infection: G9364

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

AND

Antibiotic regimen prescribed: G9498

Numerator

Patients who were prescribed amoxicillin, with or without clavulanate, as a first line antibiotic at the time of diagnosis

Numerator Options:

Performance Met:

Amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis (G9315)

OR

Denominator Exception:

Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason (G9313)

OR

Performance Not Met:

Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given (G9314)