1. No category

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