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

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Updated: 11/11/2020
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CMS 154 / Quality ID #065

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 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. Add a Start Date to the problem.
Denominator Exclusions:	If patient has a competing condition for Respiratory Conditions (e.g., pneumonia, venereal disease, UTI, Otitis media, or Whooping Cough). 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 Problems 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. 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:	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:	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