2017 MIPS Measure #116: Avoidance of Antibiotic Treatment in Adults With Acute Bronchitis

Measure Description

The percentage of adults 18-64 years of age with a diagnosis of acute bronchitis who were not dispensed an antibiotic prescription

Instruction

This measure is to be reported at each occurrence of acute bronchitis during the performance period. This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

Denominator

All patients aged 18 through 64 years of age with an outpatient or emergency department (ED) visit with a diagnosis of acute bronchitis during the measurement period

DENOMINATOR NOTE: To determine eligibility, look for any of the listed antibiotic drugs below in the 30 days
prior to the visit with the acute bronchitis diagnosis. As long as there are no prescriptions for the listed
antibiotics during this time period, the patient is eligible for denominator inclusion. Do not include ED visits that
result in an inpatient admission. An ED visit results in an inpatient admission when the ED date of service and
the admission date for the inpatient stay are one calendar day apart or less.

*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 registrybased
measures.

Denominator Criteria (Eligible Cases):
Patients18 through 64 years of age on date of encounter
AND
Diagnosis for acute bronchitis (ICD-10-CM): J20.3, J20.4, J20.5, J20.6, J20.7, J20.8, J20.9
AND
Patient encounter during the performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439, G0463*, T1015*
AND NOT
DENOMINATOR EXCLUSIONS:
ED visits that result in an inpatient admission
OR
Documentation of medical reason(s) for prescribing or dispensing antibiotic (e.g., intestinal infection, pertussis, bacterial infection, Lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/adenoids, prostatitis, cellulitis/mastoiditis/bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia, gonococcal infections/venereal disease (syphilis, chlamydia, inflammatory diseases [female reproductive organs]), infections of the kidney, cystitis/UTI, acne, HIV disease/asymptomatic HIV, cystic fibrosis, disorders of the immune system, malignancy neoplasms, chronic bronchitis, emphysema, bronchiectasis, extrinsic allergic alveolitis, chronic airway obstruction, chronic obstructive asthma, pneumoconiosis and other lung disease due to external agents, other diseases of the respiratory system, and tuberculosis: G9712
OR
Patients who use hospice services any time during the measurement period: G9713

Numerator

Patients who were not prescribed or dispensed antibiotics on or within 3 days of the initial date of service

Numerator Instructions: For performance, the measure will be calculated as the number of patient
encounters where antibiotics were neither prescribed nor dispensed on or within 3 days of the episode for
acute bronchitis over the total number of encounters in the denominator (patients aged 18 through 64 years
with an outpatient or ED visit for acute bronchitis). A higher score indicates appropriate treatment of patients
with acute bronchitis (e.g., the proportion for whom antibiotics were not prescribed or dispensed on or three
days after the encounter).

Antibiotic Medications

Numerator Options:
Performance Met: Antibiotic neither prescribed nor dispensed (4124F)
OR
Performance Not Met: Antibiotic prescribed or dispensed (4120F)