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. 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 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 # 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 Medications, 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.) ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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