Measure Name: Treatment without 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 and were not dispensed an prescription within three days of the encounter. General Criteria Summary 1. Continuous enrollment: One year prior to the date of the acute bronchitis index encounter through 7 days following that date (373 days) 2. Index Episode based: Yes 3. Anchor date: Episode date 4. Gaps in enrollment: One 45-day gap allowed in the period of continuous enrollment 5. Medical coverage: Yes 6. Drug coverage: Yes 7. Attribution time frame: Episode date 8. Exclusions apply: None 9. Age range: 18-64 10. 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 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 # Evnt Detailed Criteria Timeframe Age is 18 years or older Age in Years >= 18 As of the beginning of the year prior to the measurement year AND Age is 64 years or less Age in Years <= 64 As of the end of the measurement year

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 Detailed Criteria Timeframe At least one outpatient or 1 CPT Procedure Code= Table AAB-B: From the beginning of the measurement year to 7 days prior to the end of the measurement emergency department visit with a Codes to Identify Visit Type year principal diagnosis of acute or bronchitis Revenue Code UB= Table AAB-B: Codes (Note: Identify all visits that meet to Identify Visit Type) the above criteria. Check each And visit against the remaining Any Diagnosis Code = 466.0 (Acute denominator inclusion criteria.) bronchitis) AND No history of a comorbid 1 All Diagnosis Codes = Table AAB-C: From 12 months prior to the date of the acute bronchitis encounter through the date of the condition during the year prior to Codes to Identify Comorbid Conditions encounter the bronchitis encounter AND No antibiotic medication 1 No new, refilled, or active drug During the 90 day period prior to the acute bronchitis visit date (Note: 90 days is required to prescribed or refilled within 30 prescriptions where NDC Number Code = determine if there was a mail order prescription filled that is still active on the visit date.) days prior to the acute bronchitis Table AAB-D: Antibiotic , visit or still active on the date of the visit 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 to Identify Competing Diagnoses date of the encounter encounter to 7 days after 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.)

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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 Detailed Criteria Timeframe No antibiotic medication 1 NDC Number Code <> Table AAB-D: On or during the 3 day period following the date of the index encounter dispensing events on or during the Antibiotic Medications, 3 day period following the date of the acute bronchitis index HEDIS 2013,Table AAB-D and NDC list encounter 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 Description: Outpatient Visit 99201 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 99202 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. 99203 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. 99204 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. 99205 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 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 99212 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. 99213 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; 99214 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. 99215 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. 99217 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." 99218 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 99219 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. 99220 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. 99241 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. 99242 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. 99243 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 99244 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 99245 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 99385 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 99386 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 99395 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 99396 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 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes 99402 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes 99403 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes 99404 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes 99411 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes 99412 Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes 99420 Administration and interpretation of health risk assessment instrument (eg, health hazard appraisal) 99429 Unlisted preventive medicine service UB Revenue Description: Outpatient Visit 0510 CLINIC 0511 CHRONIC PAIN CL 0512 DENTAL CLINIC 0513 PSYCH CLINIC 0514 OB-GYN CLINIC 0515 PEDS CLINIC 0516 URGENT CLINIC 0517 FAMILY CLINIC 0519 OTHER CLINIC 0520 FREESTAND CLINIC 0521 RURAL/CLINIC 0522 RURAL/HOME 0523 FR/STD 0526 FR/STD URGENT CLINIC 0527 FR/STD 0528 FR/STD 0529 OTHER FR/STD CLINIC 0981 PRO/ER 0982 PRO FEE/OUTPT 0983 PRO FEE/CLINIC

CPT Procedure Code Description: Emergency department Visit 99281 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 problems

99282 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 99283 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 99284 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 99285 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 UB Revenue Description: Emergency department Visit 0450 EMERG ROOM 0451 ER/EMTALA 0452 ER/BEYOND EMTALA 0456 URGENT CARE 0459 OTHER EMER ROOM 0981 PRO FEE/ER

Table AAB-C: Codes to Identify Comorbid Conditions ICD-9-CM Diagnosis Description: HIV disease; asymptomatic HIV 042 Human immunodeficiency virus (HIV) disease V08 Asymptomatic human immunodeficiency virus (HIV) status ICD-9-CM Diagnosis Description: 2770* Cystic fibrosis ICD-9-CM Diagnosis Description: Disorders of the immune system 279* Disorders involving the immune mechanism ICD-9-CM Diagnosis Description: Malignancy neoplasms 140* Malignant neoplasm of lip 141* Malignant neoplasm of tongue 142* Malignant neoplasm of major salivary glands 143* Malignant neoplasm of gum 144* Malignant neoplasm of floor of mouth 145* Malignant neoplasm of other and unspecified parts of mouth 146* Malignant neoplasm of oropharynx 147* Malignant neoplasm of nasopharynx 148* Malignant neoplasm of hypopharynx 149* Malignant neoplasm of other and ill-defined sites with in the kip, oral cavity, and 150* Malignant neoplasm of esophagus 151* Malignant neoplasm of stomach 152* Malignant neoplasm of small intestine, including duodenum 153* Malignant neoplasm of colon 154* Malignant neoplasm of rectum, rectosigmoid junction, and anus 155* Malignant neoplasm of liver and interhepatic bile ducts 156* Malignant neoplasm of gallbladder and extrahepatic bile ducts 157* Malignant neoplasm of pancreas 158* Malignant neoplasm of retroperitoneum and peritoneum 159* Malignant neoplasm of other and ill-defined sites within the digestive organs and peritoneum 160* Malignant neoplasm of nasal cavities, middle ear, and accessory sinuses 161* Malignant neoplasm of 162* Malignant neoplasm of , , and lung 163* Malignant neoplasm of pleura 164* Malignant neoplasm of thymus, heart, and 165* Malignant neoplasm of other ill-defined sites within the and intrathoracic organs 170* Malignant neoplasm of bone and articular cartilage 171* Malignant neoplasm of connective and other soft tissue 172* Malignant melanoma of skin 173* Other and unspecified malignant neoplasm of the skin 174* Malignant neoplasm of female breast 175* Malignant neoplasm of male breast 176* Kaposi's sarcoma 179 Malignant neoplasm of uterus-part unspecified 180* Malignant neoplasm of cervix uteri 181 Malignant neoplasm of placenta 182* Malignant neoplasm of body of uterus 183* Malignant neoplasm of ovary and other uterine adnexa 184* Malignant neoplasm of other and unspecified female genital organs 185 Malignant neoplasm of prostate 186* Malignant neoplasm of testis 187* Malignant neoplasm of penis and other male genital organs 188* Malignant neoplasm of bladder 189* Malignant neoplasm of kidney and other and unspecified urinary organs 190* Malignant neoplasm of eye 191* Malignant neoplasm of brain 192* Malignant neoplasm of other and unspecified parts of the nervous system 193 Malignant neoplasm of thyroid gland 194* Malignant neoplasm of other endocrine glands and related structures 195* Malignant neoplasm of other and ill-defined sites 196* Secondary and unspecified malignant neoplasm of lymph nodes 197* Secondary malignant neoplasm of respiratory and digestive systems 198* Secondary malignant neoplasm of other specified sites 199* Malignant neoplasm without specification of site 200* Lymphosarcoma and reticulosarcoma and other specified malignant tumors of lymphatic tissue 201* Hodgkin's disease 202* Other malignant neoplasms of lymphoid and histiocytic tissue 203* Multiple myeloma and immunoproliferative neoplasms 204* Lymphoid leukemia 205* Myeloid leukemia 206* Monocytic leukemia 207* Other specified leukemia 208* Leukemia of unspecified cell type 209* Neuroendocrine tumors ICD-9-CM Diagnosis Description: Chronic bronchitis 491* Chronic bronchitis ICD-9-CM Diagnosis Description: Emphysema 492* Emphysema ICD-9-CM Diagnosis Description: 494* Bronchiectasis ICD-9-CM Diagnosis Description: Extrinsic allergic alveolitis 495* Extrinsic allergic alveolitis ICD-9-CM Diagnosis Description: Chronic , chronic obstructive 493.2* Chronic obstructive asthma 496 Chronic airway obstruction not elsewhere classified ICD-9-CM Diagnosis Description: Pneumocconiosis and other lung disease due to external agent 500 Coal workers' 501 502 Pneumoconiosis due to other silica or silicates 503 Pneumoconiosis due to other inorganic dust 504 Pneumonopathy due to inhalation of other dust 505 Pneumoconiosis unspecified 506* Respiratory conditions due to chemical fumes and vapors 507* due to solids and liquids 508* Respiratory conditions due to other and unspecified external agents ICD-9-CM Diagnosis Description: Other diseases of the respiratory system 510* Empyema 511* 512* 513* of lung and mediastinum 514 Pulmonary congestion and hypostasis 515 Postinflammatory 516* Other alveolar and parietoalveolar pneumonopathy 517* Lung involvement in conditions classified elsewhere 518* Other diseases of the lung 519* Other diseases of respiratory system ICD-9-CM Diagnosis Description: Tuberculosis 010* Primary tuberculous infection 011* Pulmonary tuberculosis 012* Other respiratory tuberculous 013* Tuberculous of meninges and central nervous system 014* Tuberculous of intestines, peritoneum, and mesenteric glands 015* Tuberculosis of bones and joints 016* Tuberculosis of genitourinary system 017* Tuberculosis of other organs 018* Miliary tuberculosis

Table URI-C: Codes to Identify Competing Diagnoses

ICD-9-CM Diagnosis Description: Intestinal 001* Cholera 002* Typhoid and paratyphoid 003* Other salmonella infections 004* Shigellosis 005* Other food poisoning (bacterial) 006* Amebiasis 007* Other protozoal intestinal diseases 008* Intestinal infection due to other organisms 009* Ill-defined intestinal infections ICD-9-CM Diagnosis Description: Pertussis 033* Whooping cough ICD-9-CM Diagnosis Description: Bacterial infection unspecified 041.9 Bacterial infection unspecified in conditions classified elsewhere and of unspecified site ICD-9-CM Diagnosis Description: Lyme disease and other arthropod-borne diseases 088* Other arthropod-borne diseases ICD-9-CM Diagnosis Description: Otitis media 382* Suppurative and unspecified otitis media ICD-9-CM Diagnosis Description: Acute 461* Acute sinusitis ICD-9-CM Diagnosis Description: Acute 462 Acute pharyngitis 034.0 Streptococcal sore ICD-9-CM Diagnosis Description: Acute tonsillitis 463 Acute tonsillitis ICD-9-CM Diagnosis Description: Chronic sinusitis 473* Chronic sinusitis ICD-9-CM Diagnosis Description: Infections of the pharynx, larynx, , adenoids 464.1* Acute 464.2* Acute laryngotracheitis 464.3* Acute 474* Chronic disease of tonsils and adenoids 478.21 Cellulitis of pharynx or nasopharynx 478.22 Parapharyngeal abscess 478.24 478.29 Other diseases of pharynx or nasopharynx 478.71 Cellulitis and perichondritis of larynx 478.79 Other diseases of larynx 478.9 Other and unspecified diseases of upper ICD-9-CM Diagnosis Description: Prostatitis 601* Inflammatory diseases of prostate ICD-9-CM Diagnosis Description: Cellulitis, mastoiditis, other bone infections 383* Mastoiditis and related conditions 681* Cellulitis and abscess of finger and toe 682* Other cellulitis and abscess 730* Osteomyelitis, periostitis, and other infections involving bone ICD-9-CM Diagnosis Description: Acute lymphadenitis 683 Acute lymphadenitis ICD-9-CM Diagnosis Description: Impetigo 684 Impetigo ICD-9-CM Diagnosis Description: Skin staph infections 686* Other local infections of skin and subcutaneous tissue ICD-9-CM Diagnosis Description: 481 Pneumococcal pneumonia 482* Other 483* Pneumonia due to other specified organism 484* Pneumonia in infectious diseases classified elsewhere 485 organism unspecified 486 Pneumonia organism unspecified ICD-9-CM Diagnosis Description: Gonococcal infections and venereal diseases 098* Gonococcal infections 099* Other venereal diseases V01.6 Contact with or exposure to venereal diseases V02.7 Contact with or exposure to other viral diseases ICD-9-CM Diagnosis Description: Syphilis 090* Congenital syphilis 091* Early syphilis, symptomatic 092* Early syphilis, latent 093* Cardiovascular syphilis 094* Neurosyphilis 095* Other forms of late syphilis, with symptoms 096* Late syphilis, latent 097* Other and unspecified syphilis 098* Gonococcal infections 099* Other venereal diseases ICD-9-CM Diagnosis Description: Chlamydia 078.88 Other specified diseases due to 079.88 Other specified chlamydial infection 079.98 Unspecified chlamydial infection ICD-9-CM Diagnosis Description: Inflammatory diseases (female reproductive organs) 131* Trichomoniasis 614* Inflammatory disease of ovary, fallopian tube, pelvic cellular tissue, and peritoneum 615* Inflammatory diseases of uterus, except cervix 616* Inflammatory disease of cervix, vagina, and vulva ICD-9-CM Diagnosis Description: Infections of the kidney 590* Infections of kidney ICD-9-CM Diagnosis Description: Cystitis or UTI 595* Cystitis 599.0 Urinary tract infection, site not specified ICD-9-CM Diagnosis Description: Acne 706.0 Acne varioliformis 706.1 Other acne