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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
093 0654 Process Yes Efficiency and Cost Reduction Registry

Measure Description

Percentage of patients aged 2 years and older with a diagnosis of AOE who were not prescribed systemic antimicrobial therapy

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 #91: Acute Otitis Externa: Topical Therapy to be clinically relevant. The measure developer intended for Quality ID #91: Acute Otitis Externa: TopicalTherapy and Quality ID #93: Acute Otitis Externa: Systemic Antimicrobial Therapy – Avoidance of Inappropriate Use to be paired measures, as they can both be implemented to measure care provided to patients diagnosed with diffuse, uncomplicated AOE.

NOTE: No notes related

Measure Submission

The listed denominator criteria are 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 not prescribed systemic antimicrobial therapy

Definition

Numerator Instructions: For performance, the measure will be calculated as the number of patients for whom systemic antimicrobial therapy was not prescribed over the number of patients in the denominator (patients aged 2 years and older with acute otitis externa). A higher score indicates appropriate treatment of patients with AOE (e.g., the proportion for whom systemic antimicrobials were not prescribed)

Numerator Quality-Data Coding Options

Denominator Exclusion: 4131F with 1P:
Systemic Antimicrobial Therapy Prescribed for Medical Reasons:

Append a modifier (1P) to CPT Category II code 4131F to submit documented circumstances that appropriately exclude patients from the denominator

Documentation of medical reason(s) for prescribing systemic antimicrobial therapy

Performance Met: CPT II 4132F:
Systemic Antimicrobial Therapy Not Prescribed

 

Systemic antimicrobial therapy not prescribed

Performance Not Met: 4131F:
Systemic Antimicrobial Therapy Prescribed:

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.

Systemic antimicrobial therapy prescribed

NUMERATOR NOTE: Denominator Exception is 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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