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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
091 0653 Process Yes Effective Clinical Care Registry

Measure Description

Percentage of patients aged 2 years and older with a diagnosis of AOE who were prescribed topical preparations

Instructions

This measure may be submitted based on the actions of the submitting eligible clinician who performs the quality action, described in the measure, based on services provided within measure-specific denominator coding. This measure is to be submitted once for each occurrence of AOE during the performance period. For the purpose of submitting this measure, only unique occurrences with an onset of AOE diagnosing within the current performance period will be submitted. A unique occurrence of AOE is defined as the period of time that begins with the onset of AOE diagnosing and ends 30 days after the onset of diagnosing. Claims data will be analyzed to determine unique occurrences. If multiple claims are submitted within that 30-day period, only one instance of submission will be counted.


Eligible clinicians who submit this measure may also find Quality ID #93: Acute Otitis Externa: Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use to be clinically relevant. The measure developer intended for Quality ID #91: Acute Otitis Externa (AOE): Topical Therapy and Quality ID #93: Acute Otitis Externa (AOE): Systemic Antimicrobial Therapy- Avoidance of Inappropriate Use to be paired measures, as they can both be implementedto measure care provided to patients diagnosed with diffuse, uncomplicated AOE.

NOTE: No notes related

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure specific coding should be submitted on the claim(s) representing the eligible encounter.

Numerator

Patients who were prescribed topical preparations

Definition

Prescribed – May include prescription given to the patient for topical preparations at one or more visits during the episode of AOE OR patient already receiving topical preparations as documented in the current medication list.

Numerator Quality-Data Coding Options

Denominator Exclusion: 4130F with 1P:
Topical Preparations Not Prescribed for Acute Otitis Externa for a Medical Reason:

Append a modifier (1P) to CPT Category II code 4130F to submit documented circumstances that appropriately exclude patients from the denominator

Documentation of medical reason(s) for not prescribing topical preparations (including OTC) for acute otitis externa

OR

Denominator Exclusion: 4130F with 2P:
Topical Preparations Not Prescribed for Acute Otitis Externa for a Patient Reason:

Append a modifier (2P) to CPT Category II code 4130F to submit documented circumstances that appropriately exclude patients from the denominator.

Documentation of patient reason(s) for not prescribing topical preparations (including OTC) for acute otitis externa

Performance Met: CPT II 4130F:
Topical Preparations Prescribed for Acute Otitis Externa

Topical preparations (including OTC) prescribed foracute otitis externa

Performance Not Met: 4130F with 8P:
Topical Preparations Not Prescribed for Acute Otitis Externa, Reason not Otherwise Specified:

Append a submission modifier (8P) to CPT Category II code 4130F to submit circumstances when the action described in the numerator is not performed and the reason is not otherwise specified.

Topical preparations (including OTC) for acute otitis externa (AOE) not prescribed, reason not otherwise specified

NUMERATOR NOTE: Denominator Exception(s) are determined on the date of the denominator eligible encounter/diagnosis

Denominator

All patients aged 2 years and older with a diagnosis of AOE

DENOMINATOR NOTE: A new diagnosis code indicates a new occurrence of AOE. If a patient presents with right ear AOE then returns with new onset of left ear AOE symptoms, then the left ear AOE would be considered a new unique occurrence, separate from the right ear AOE.

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥ 2 years on date of encounter

AND

Diagnosis for AOE (ICD-10-CM): H60.311, H60.312, H60.313, H60.319, H60.321, H60.322, H60.323, H60.329, H60.331, H60.332, H60.333, H60.339, H60.391, H60.392, H60.393, H60.399, H60.501, H60.502, H60.503, H60.509, H60.511, H60.512, H60.513, H60.519, H60.521, H60.522, H60.523, H60.529, H60.531, H60.532, H60.533, H60.539, H60.541, H60.542, H60.543, H60.549, H60.551, H60.552, H60.553, H60.559, H60.591, H60.592, H60.593, H60.599, H60.8X3, H62.40, H62.41, H62.42, H62.43

 

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