CMS Measure ID: #464
Collection Type: CQM
Reporting Frequency: Once per episode of treatment
Outcome: No
High Priority: Yes
NQS Domain: Person and Caregiver-Centered Experience Outcomes
Measure Age: > 2 years
Instructions
This measure is to be submitted once for each occurrence of otitis media with effusion (OME) in children seen during the performance period. Each unique occurrence is defined as a 90-day period from onset of OME. If multiple occurrences are documented within a 90-day period, eligible clinicians should submit one instance.
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 2 months through 12 years with a diagnosis of OME who were not prescribed systemic antimicrobials
2023 Benchmarks (from 2021 CMS data)
Registry
Topped out: Yes
Capped at 7: Yes
Decile 0: 0 – 5.87
Decile 1: 5.88 – 69.99
Minimum: 70 – 83.55
Decile 3: 83.56 – 88.82
Decile 4: 88.83 – 95.05
Decile 5: 95.06 – 97.07
Decile 6: 97.08 – 98.2
Decile 7: 98.21 – 99.99
Decile 10: 100 – 100
Denominator
All patients aged 2 months through 12 years with a diagnosis of OME
DENOMINATOR NOTE: *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 aged 2 months through 12 years on the date of the encounter
AND
Diagnosis for OME (ICD-10-CM):
H65.90, H65.91, H65.92, H65.93, H65.111, H65.112, H65.113, H65.114, H65.115, H65.116, H65.117, H65.119, H65.191, H65.192, H65.193, H65.194, H65.195, H65.196, H65.197, H65.199, H65.411, H65.412, H65.413, H65.419, H65.491, H65.492, H65.493, H65.499
AND
Patient encounter during the performance period (CPT):
99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99242*, 99243*, 99244*, 99245*, 99381*, 99382*, 99383*, 99384*, 99391*, 99392*, 99393*, 99394*
Numerator
Patients who were not prescribed systemic antimicrobials
Numerator Instructions:
For performance, the measure will be calculated as the number of patients for whom systemic antimicrobials were neither prescribed nor recommended over the number of patients in the denominator (patients aged 2 months through 12 years with a diagnosis of OME). A higher score indicates appropriate treatment of patients with OME (e.g., the proportion for whom systemic antimicrobials were not prescribed).
Numerator Options:
Performance Met:
Systemic antimicrobials not prescribed (G9959)
OR
Denominator Exception:
Documentation of medical reason(s) for prescribing systemic antimicrobials (G9960)
OR
Performance Not Met:
Systemic antimicrobials prescribed (G9961)