CMS 154 - Appropriate Treatment for Children with Upper Respiratory Infection (URI)

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Updated: 08/23/2021
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CMS 154 / Quality ID #065

Percentage of children 3 months of age or older with a diagnosis of upper respiratory infection (URI) that did NOT result in an antibiotic dispensing event.

Denominator:	Outpatient visits, telephone visits, online assessments, observation stays or emergency department visits with a diagnosis of URI during the measurement period among patients 3 months of age and older. Patient’s age is calculated based on the patient’s Date of Birth, which was entered when you created the patient’s account. Create a note detailing the patient’s office visit. The diagnosis of "Upper Respiratory Infection (URI)" is entered in the patient’s Problem List with a Start Date.
Denominator Exclusions:	Exclude URI episodes when the patient had a competing comorbid condition during the 12 months prior to or on the episode date. Competing conditions are 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 the Problem List with a Start Date within the previous 30 days. Antibiotics are prescribed in Medications with a start date that is within the 30 days prior to the date of the diagnosis. Exclude URI episodes when the patient had competing diagnosis on or three days after the episode date. Competing diagnosis is documented in tthe Problem List with a Start Date. These patients will be excluded from the denominator. If patient was in Hospice during the measurement period: Hospice is documented under Hospitalizations/Procedures in History. These patients will be excluded from the denominator.
Numerator:	URI episodes without a prescription for antibiotic medication on or 3 days after the outpatient visit, telephone visit, online assessment, observation stay or emergency department 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:	Enter Procedure Codes including E/M Codes or HCPCS Codes on the Superbill. Complete and sign the note. Once all steps have been completed, the measure will be added to the Quality Measures Report.
Measure type:	Process
High Priority Measure:	Yes
Telehealth Eligible:	Yes