2020 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 prescribed or dispensed an antibiotic prescription

Instructions

This measure is to be submitted at each occurrence of acute bronchitis during the performance period. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. 

Measure Submission Type:

The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.

Denominator

All patients aged 18 through 64 years of age with an outpatient, observation 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.

*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 MIPS CQMs.

Denominator Criteria (Eligible Cases):

Patients 18 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): 98966, 98967, 98968, 98969, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99217, 99218, 99219, 99220, 99241*, 99242*, 99243*, 99244*, 99245*, 99281, 99282, 99283, 99284, 99285, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381*, 99382*, 99383*, 99384*, 99385*, 99386*, 99387*, 99391*, 99392*, 99393*, 99394*, 99395*, 99396*, 99397*, 99401*, 99402*, 99403*, 99404*, 99411*, 99412*, 99429*, 99441, 99442, 99443, 99444, 99455, 99456, 99483, G0402, G0438, G0439, G0463*, T1015*

AND NOT

DENOMINATOR EXCLUSIONS:

Observation or 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, observation 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)