Measure Name: Acute Bronchitis Treatment without Antibiotics Owner: Measure Code:
Transcription
Measure Name: Acute Bronchitis Treatment without Antibiotics Owner: Measure Code:
Measure Name: Acute Bronchitis Treatment without Antibiotics Owner: NCQA (AAB) Measure Code: BRN Lab Data: N Rule Description: The percentage of adults 18-64 years of age who had a diagnosis of acute bronchitis and were not dispensed an antibiotic prescription within three days of the encounter. General Criteria Summary 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Continuous enrollment: One year prior to the date of the acute bronchitis index encounter through 7 days following that date (373 days) Index Episode based: Yes Anchor date: Episode date Gaps in enrollment: One 45-day gap allowed in the period of continuous enrollment Medical coverage: Yes Drug coverage: Yes Attribution time frame: Episode date Exclusions apply: None Age range: 18-64 Intake period: All but the last 7 days of the measurement year Summary of changes for 2013 1. No changes to this measure. -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------Denominator Description: All patients, aged 18 years as of the beginning of the year prior to the measurement year to 64 years as of the end of the measurement year, who had an outpatient or emergency department encounter with a diagnosis of acute bronchitis Inclusion Criteria: Patients as above with no comorbid condition during the twelve month period prior to the encounter, no prescription for an antibiotic medication filled 30 days prior to the encounter, and no competing diagnosis during the period from 30 days prior to the encounter to 7 days after the encounter. The intake period is from the beginning of the measurement year to 7 days prior to the end of the measurement year. Eligibility Criteria Condition Description Age is 18 years or older # Evnt Detailed Criteria Timeframe Age in Years >= 18 As of the beginning of the year prior to the measurement year Age in Years <= 64 As of the end of the measurement year AND Age is 64 years or less AND Has medical coverage Coverage Indicator Medical = Y From 365 days prior to the date of the index encounter through 7 days following the date of the index encounter AND Has drug coverage Coverage Indicator Drug = Y From 365 days prior to the date of the index encounter through 7 days following the date of the index encounter Claim Criteria Condition Description # Evnt At least one outpatient or emergency department visit with a principal diagnosis of acute bronchitis 1 Detailed Criteria CPT Procedure Code= Table AAB-B: Codes to Identify Visit Type Timeframe From the beginning of the measurement year to 7 days prior to the end of the measurement year or Revenue Code UB= Table AAB-B: Codes to Identify Visit Type) And (Note: Identify all visits that meet the above criteria. Check each visit against the remaining denominator inclusion criteria.) Any Diagnosis Code = 466.0 (Acute bronchitis) AND No history of a comorbid condition during the year prior to the bronchitis encounter AND 1 All Diagnosis Codes = Table AAB-C: Codes to Identify Comorbid Conditions From 12 months prior to the date of the acute bronchitis encounter through the date of the encounter No antibiotic medication prescribed or refilled within 30 days prior to the acute bronchitis visit or still active on the date of the visit 1 No new, refilled, or active drug prescriptions where NDC Number Code = Table AAB-D: Antibiotic Medications, During the 90 day period prior to the acute bronchitis visit date (Note: 90 days is required to determine if there was a mail order prescription filled that is still active on the visit date.) HEDIS 2013,Table AAB-D and NDC list are available at http://www.ncqa.org/HEDISQualityMeasur ement/HEDISMeasures/HEDIS2013/HEDI S2013FinalNDCLists.aspx A prescription is active if the prescription was filled more than 30 days prior to the bronchitis visit date and the Days Supply is greater than or equal to the number of days between the prescription fill date and the bronchitis visit date. AND No competing diagnosis from 30 1 All Diagnosis Codes = Table URI-C: Codes From 30 days prior to the date of the acute bronchitis encounter through 7 days following the days prior to the bronchitis encounter to 7 days after the encounter to Identify Competing Diagnoses date of the encounter (Note: Identify all visits that meet the above criteria. Then select the visit with the earliest date and use that as the index encounter.) ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Numerator Description: For each patient who meets the denominator criteria, those who did not receive an antibiotic drug on or during the 3 day period following their acute bronchitis encounter Inclusion Criteria: Patients who did not have a prescription for an antibiotic drug on or up to three days following the date of their acute bronchitis index encounter Condition Description # Evnt No antibiotic medication dispensing events on or during the 3 day period following the date of the acute bronchitis index encounter 1 Detailed Criteria NDC Number Code <> Table AAB-D: Antibiotic Medications, Timeframe On or during the 3 day period following the date of the index encounter HEDIS 2013,Table AAB-D and NDC list are available at http://www.ncqa.org/HEDISQualityMeasur ement/HEDISMeasures/HEDIS2013/HEDI S2013FinalNDCLists.aspx Appendix Table AAB-B: Codes to Identify Visit Type CPT Procedure Code 99201 99202 99203 99204 99205 Description: Outpatient Visit Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. 99211 99212 99213 99214 99215 99217 99218 99219 99220 99241 99242 99243 99244 99245 99385 99386 99395 99396 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Observation care discharge day management (This code is to be utilized by the physician to report all services provided to a patient on discharge from "observation status" if the discharge is on other than the initial date of "observation status." Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Office consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers Office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other providers New patient, 18-39 years, Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization New patient, 40-64 years, Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization Established patient, 18-39 years, Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization Established patient, 40-64 years, Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of appropriate immunization 99401 99420 99429 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes Administration and interpretation of health risk assessment instrument (eg, health hazard appraisal) Unlisted preventive medicine service UB Revenue 0510 0511 0512 0513 0514 0515 0516 0517 0519 0520 0521 0522 0523 0526 0527 0528 0529 0981 0982 0983 Description: Outpatient Visit CLINIC CHRONIC PAIN CL DENTAL CLINIC PSYCH CLINIC OB-GYN CLINIC PEDS CLINIC URGENT CLINIC FAMILY CLINIC OTHER CLINIC FREESTAND CLINIC RURAL/CLINIC RURAL/HOME FR/STD FR/STD URGENT CLINIC FR/STD FR/STD OTHER FR/STD CLINIC PRO/ER PRO FEE/OUTPT PRO FEE/CLINIC CPT Procedure Code 99281 Description: Emergency department Visit Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care, self limited or minor 99402 99403 99404 99411 99412 problems 99282 99283 99284 99285 UB Revenue 0450 0451 0452 0456 0459 0981 Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care, low to moderate severity Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care, moderate severity Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care, high severity Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; high severity with threat to life Description: Emergency department Visit EMERG ROOM ER/EMTALA ER/BEYOND EMTALA URGENT CARE OTHER EMER ROOM PRO FEE/ER Table AAB-C: Codes to Identify Comorbid Conditions ICD-9-CM Diagnosis 042 V08 ICD-9-CM Diagnosis 2770* ICD-9-CM Diagnosis 279* ICD-9-CM Diagnosis 140* 141* 142* 143* 144* 145* 146* 147* Description: HIV disease; asymptomatic HIV Human immunodeficiency virus (HIV) disease Asymptomatic human immunodeficiency virus (HIV) infection status Description: Cystic fibrosis Cystic fibrosis Description: Disorders of the immune system Disorders involving the immune mechanism Description: Malignancy neoplasms Malignant neoplasm of lip Malignant neoplasm of tongue Malignant neoplasm of major salivary glands Malignant neoplasm of gum Malignant neoplasm of floor of mouth Malignant neoplasm of other and unspecified parts of mouth Malignant neoplasm of oropharynx Malignant neoplasm of nasopharynx 148* 149* 150* 151* 152* 153* 154* 155* 156* 157* 158* 159* 160* 161* 162* 163* 164* 165* 170* 171* 172* 173* 174* 175* 176* 179 180* 181 182* 183* 184* 185 186* 187* 188* 189* 190* Malignant neoplasm of hypopharynx Malignant neoplasm of other and ill-defined sites with in the kip, oral cavity, and pharynx Malignant neoplasm of esophagus Malignant neoplasm of stomach Malignant neoplasm of small intestine, including duodenum Malignant neoplasm of colon Malignant neoplasm of rectum, rectosigmoid junction, and anus Malignant neoplasm of liver and interhepatic bile ducts Malignant neoplasm of gallbladder and extrahepatic bile ducts Malignant neoplasm of pancreas Malignant neoplasm of retroperitoneum and peritoneum Malignant neoplasm of other and ill-defined sites within the digestive organs and peritoneum Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses Malignant neoplasm of larynx Malignant neoplasm of trachea, bronchus, and lung Malignant neoplasm of pleura Malignant neoplasm of thymus, heart, and mediastinum Malignant neoplasm of other ill-defined sites within the respiratory system and intrathoracic organs Malignant neoplasm of bone and articular cartilage Malignant neoplasm of connective and other soft tissue Malignant melanoma of skin Other and unspecified malignant neoplasm of the skin Malignant neoplasm of female breast Malignant neoplasm of male breast Kaposi's sarcoma Malignant neoplasm of uterus-part unspecified Malignant neoplasm of cervix uteri Malignant neoplasm of placenta Malignant neoplasm of body of uterus Malignant neoplasm of ovary and other uterine adnexa Malignant neoplasm of other and unspecified female genital organs Malignant neoplasm of prostate Malignant neoplasm of testis Malignant neoplasm of penis and other male genital organs Malignant neoplasm of bladder Malignant neoplasm of kidney and other and unspecified urinary organs Malignant neoplasm of eye 191* 192* 193 194* 195* 196* 197* 198* 199* 200* 201* 202* 203* 204* 205* 206* 207* 208* 209* ICD-9-CM Diagnosis 491* ICD-9-CM Diagnosis 492* ICD-9-CM Diagnosis 494* ICD-9-CM Diagnosis 495* ICD-9-CM Diagnosis 493.2* 496 ICD-9-CM Diagnosis 500 501 502 503 504 505 506* Malignant neoplasm of brain Malignant neoplasm of other and unspecified parts of the nervous system Malignant neoplasm of thyroid gland Malignant neoplasm of other endocrine glands and related structures Malignant neoplasm of other and ill-defined sites Secondary and unspecified malignant neoplasm of lymph nodes Secondary malignant neoplasm of respiratory and digestive systems Secondary malignant neoplasm of other specified sites Malignant neoplasm without specification of site Lymphosarcoma and reticulosarcoma and other specified malignant tumors of lymphatic tissue Hodgkin's disease Other malignant neoplasms of lymphoid and histiocytic tissue Multiple myeloma and immunoproliferative neoplasms Lymphoid leukemia Myeloid leukemia Monocytic leukemia Other specified leukemia Leukemia of unspecified cell type Neuroendocrine tumors Description: Chronic bronchitis Chronic bronchitis Description: Emphysema Emphysema Description: Bronchiectasis Bronchiectasis Description: Extrinsic allergic alveolitis Extrinsic allergic alveolitis Description: Chronic airway obstruction, chronic obstructive asthma Chronic obstructive asthma Chronic airway obstruction not elsewhere classified Description: Pneumocconiosis and other lung disease due to external agent Coal workers' pneumoconiosis Asbestosis Pneumoconiosis due to other silica or silicates Pneumoconiosis due to other inorganic dust Pneumonopathy due to inhalation of other dust Pneumoconiosis unspecified Respiratory conditions due to chemical fumes and vapors 507* 508* ICD-9-CM Diagnosis 510* 511* 512* 513* 514 515 516* 517* 518* 519* ICD-9-CM Diagnosis 010* 011* 012* 013* 014* 015* 016* 017* 018* Pneumonitis due to solids and liquids Respiratory conditions due to other and unspecified external agents Description: Other diseases of the respiratory system Empyema Pleurisy Pneumothorax Abscess of lung and mediastinum Pulmonary congestion and hypostasis Postinflammatory pulmonary fibrosis Other alveolar and parietoalveolar pneumonopathy Lung involvement in conditions classified elsewhere Other diseases of the lung Other diseases of respiratory system Description: Tuberculosis Primary tuberculous infection Pulmonary tuberculosis Other respiratory tuberculous Tuberculous of meninges and central nervous system Tuberculous of intestines, peritoneum, and mesenteric glands Tuberculosis of bones and joints Tuberculosis of genitourinary system Tuberculosis of other organs Miliary tuberculosis Table URI-C: Codes to Identify Competing Diagnoses ICD-9-CM Diagnosis 001* 002* 003* 004* 005* 006* 007* 008* 009* Description: Intestinal infections Cholera Typhoid and paratyphoid fevers Other salmonella infections Shigellosis Other food poisoning (bacterial) Amebiasis Other protozoal intestinal diseases Intestinal infection due to other organisms Ill-defined intestinal infections ICD-9-CM Diagnosis 033* ICD-9-CM Diagnosis 041.9 ICD-9-CM Diagnosis 088* ICD-9-CM Diagnosis 382* ICD-9-CM Diagnosis 461* ICD-9-CM Diagnosis 462 034.0 ICD-9-CM Diagnosis 463 ICD-9-CM Diagnosis 473* ICD-9-CM Diagnosis 464.1* 464.2* 464.3* 474* 478.21 478.22 478.24 478.29 478.71 478.79 478.9 ICD-9-CM Diagnosis 601* ICD-9-CM Diagnosis 383* 681* 682* 730* ICD-9-CM Diagnosis 683 Description: Pertussis Whooping cough Description: Bacterial infection unspecified Bacterial infection unspecified in conditions classified elsewhere and of unspecified site Description: Lyme disease and other arthropod-borne diseases Other arthropod-borne diseases Description: Otitis media Suppurative and unspecified otitis media Description: Acute sinusitis Acute sinusitis Description: Acute pharyngitis Acute pharyngitis Streptococcal sore throat Description: Acute tonsillitis Acute tonsillitis Description: Chronic sinusitis Chronic sinusitis Description: Infections of the pharynx, larynx, tonsils, adenoids Acute tracheitis Acute laryngotracheitis Acute epiglottitis Chronic disease of tonsils and adenoids Cellulitis of pharynx or nasopharynx Parapharyngeal abscess Retropharyngeal abscess Other diseases of pharynx or nasopharynx Cellulitis and perichondritis of larynx Other diseases of larynx Other and unspecified diseases of upper respiratory tract Description: Prostatitis Inflammatory diseases of prostate Description: Cellulitis, mastoiditis, other bone infections Mastoiditis and related conditions Cellulitis and abscess of finger and toe Other cellulitis and abscess Osteomyelitis, periostitis, and other infections involving bone Description: Acute lymphadenitis Acute lymphadenitis ICD-9-CM Diagnosis 684 ICD-9-CM Diagnosis 686* ICD-9-CM Diagnosis 481 482* 483* 484* 485 486 ICD-9-CM Diagnosis 098* 099* V01.6 V02.7 ICD-9-CM Diagnosis 090* 091* 092* 093* 094* 095* 096* 097* 098* 099* ICD-9-CM Diagnosis 078.88 079.88 079.98 ICD-9-CM Diagnosis 131* 614* 615* 616* ICD-9-CM Diagnosis 590* Description: Impetigo Impetigo Description: Skin staph infections Other local infections of skin and subcutaneous tissue Description: Pneumonia Pneumococcal pneumonia Other bacterial pneumonia Pneumonia due to other specified organism Pneumonia in infectious diseases classified elsewhere Bronchopneumonia organism unspecified Pneumonia organism unspecified Description: Gonococcal infections and venereal diseases Gonococcal infections Other venereal diseases Contact with or exposure to venereal diseases Contact with or exposure to other viral diseases Description: Syphilis Congenital syphilis Early syphilis, symptomatic Early syphilis, latent Cardiovascular syphilis Neurosyphilis Other forms of late syphilis, with symptoms Late syphilis, latent Other and unspecified syphilis Gonococcal infections Other venereal diseases Description: Chlamydia Other specified diseases due to chlamydiae Other specified chlamydial infection Unspecified chlamydial infection Description: Inflammatory diseases (female reproductive organs) Trichomoniasis Inflammatory disease of ovary, fallopian tube, pelvic cellular tissue, and peritoneum Inflammatory diseases of uterus, except cervix Inflammatory disease of cervix, vagina, and vulva Description: Infections of the kidney Infections of kidney ICD-9-CM Diagnosis 595* 599.0 ICD-9-CM Diagnosis 706.0 706.1 Description: Cystitis or UTI Cystitis Urinary tract infection, site not specified Description: Acne Acne varioliformis Other acne