Appropriate Treatment for Children with Upper Respiratory Infection (URI)

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Updated: 06/15/2020
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Percentage of children 3 months to 18 years of age who were diagnosed with upper respiratory infection (URI) and were NOT dispensed an antibiotic prescription on or three days after the episode.

Denominator:	Children 3 months through 18 years of age who had an outpatient visit with a diagnosis of upper respiratory infection (URI) during the measurement period. Patient’s age is calculated based on the patient’s Date of Birth, which is entered when you created the patient’s account. The diagnosis of "Upper Respiratory Infection (URI)" is entered in the patient’s ProblemList. Make sure to add a Start Date to the problem.
Denominator Exclusions:	If a Competing Condition for Respiratory Conditions (i.e. pneumonia, venereal disease, UTI, acne) is documented in the Problem List, with a Start Date, these patients will be excluded from the denominator. If an "Antibiotic Medication" was prescribed in the previous 30 days and is documented in Medications, these patients will be excluded from the denominator. Patient will need to have "Pharyngitis" in Problems with a Start Date within the previous 30 days Exclude patients whose hospice care overlaps the measurement period.
Numerator:	Children without a prescription for antibiotic medication on or 3 days after the outpatient or ED visit for an upper respiratory infection. Patients for whom there is no antibiotic listed in Medications with a Start Date on or within 3 days of the Start Date of the Problem.
Office Visit Documentation:	Create a note detailing the patient’s officevisit. Enter Procedure Codes including E/M Codes or CPT/HCPCS Codes on the Superbill. Complete and sign the note. Once all steps have been completed, the measure will be added to the Quality Report.
Quality ID:	065
CMS Measure ID:	CMS154
Measure type:	Process
High Priority Measure:	Yes