CMS146v12 – Appropriate Testing for Pharyngitis

Appropriate Testing for Pharyngitis	CMS146v12	The percentage of episodes for patients 3 years and older with a diagnosis of pharyngitis that resulted in an antibiotic order on or three days after the episode date and a group A streptococcus (strep) test in the seven-day period from three days prior to the episode date through three days after the episode date
– DENOMINATOR Outpatient, telephone, online assessment (i.e. e-visit or virtual check-in), observation, or emergency department (ED) visits with a diagnosis of pharyngitis or tonsillitis from January 1 to December 28 of the measurement period and an antibiotic order on or three days after the episode date among patients 3 years or older. A qualifying encounter in this case can include any of the following: Emergency Department Evaluation and Management Visit Home Healthcare Services  Initial Hospital Observation Care Medical Disability Exam Observation  Office Visit Telephone Visits Online Assessments  Outpatient Consultation  Preventive Care Services Established Office Visit, 18 and Up Preventive Care Services Group Counseling  Unlisted Preventive Medicine Service  Preventive Care Services, Initial Office Visit, 0 to 17  Preventive Care Services, Individual Counseling  Preventive Care Services, Initial Office Visit, 18 and Up Preventive Care, Established Office Visit, 0 to 17 – NUMERATOR A group A streptococcus test in the seven-day period from three days prior to the episode date through three days after the episode date. DENOMINATOR EXCLUSIONS Exclude pharyngitis episodes where the patient is taking antibiotics in the 30 days prior to the episode date. Exclude pharyngitis episodes when the patient had a comorbid condition during the 12 months prior to or on the episode date. Exclude pharyngitis episodes when the patient had hospice care for any part of the measurement period. Exclude episodes where the patient had a competing diagnosis on or three days after the episode date.

– APPLICATION WORKFLOW

For Denominator:

• To record an encounter, use the workflow Patient > Provider Note > Create Superbill. Under the ‘Procedure- CPTs’ heading, enter the relevant encounter code.

• Workflow for medication ordered: Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Save’.

• To order an antibiotic for pharyngitis, navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Prescribe’.

• Diagnosis for pharyngitis or tonsillitis can be documented via Patient > Provider Note > Diagnoses. Here, click ‘Add’ and search for the relevant diagnosis. Fill out any details as needed and click ‘Save’. Then click ‘Accept’ to add the diagnosis to the provider note.

For Numerator:

• To record an encounter, use the workflow Patient > Provider Note > Create Superbill. Under the ‘Procedure- CPTs’ heading, enter the relevant encounter code.
• To order an antibiotic, navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Prescribe’
• Diagnosis for pharyngitis or tonsillitis can be documented via Patient > Provider Note > Diagnoses. Here, click ‘Add’ and search for the relevant diagnosis. Fill out any details as needed and click ‘Save’. Then click ‘Accept’ to add the diagnosis to the provider note.
• To place an order for ‘Group A Streptococcus Test’ use the workflow Patient > Provider Note > Orders > Lab. Here, select a laboratory and then search a test to be performed. Fill out any details necessary and once done, click ‘Save & Accept’ or ‘Sign & Accept’.

Note: The result of the lab test must not be null.

For Denominator Exclusions:

• To document that a patient is receiving hospice care outside of a hospital or long-term care facility, navigate to Patient > Provider Note > Evaluations. Use the below mentioned codes to order or perform an intervention:
  • 385763009: Hospice Care (Regime/Therapy)
  • 385765002: Hospice Care Management (Procedure)

• To document an inpatient encounter, navigate to Patient > Provider Note > Evaluations.

• To document a hospice care assessment, follow the workflow Patient > Provider Note > Evaluations. Click ‘Add’ and search for ‘Hospice Care [Minimum Data Set]’. Then select ‘Performed’ from the ‘Status’ dropdown and ‘Yes’ from the ‘Result’ field.

• A hospice encounter can be documented through Patient > Provider Note > Evaluations or Patient > Provider Note > Create Superbill.
• To record a patient’s prior intake of medication, head over to Patient > Provider Note > Medications. Click ‘Add’ and search for the relevant medication. Enter the details and once done, click ‘Save’.

• To document a patient’s
  • competing comorbid condition
  • competing diagnosis  

navigate to Patient > Provider Note > Diagnoses. Fill out any necessary details and click ‘Save’.