CMS146v13: Appropriate Testing for Pharyngitis

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

Numerator

A group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitis. Any of the following will qualify: 

  • An electronically received test's name contains any of the following phrases:
    • Strep Gp A Culture
    • Beta Strep Gp A Culture
    • STREPTOCOCCUS, GRP A
    • STREP SCREEN
  • The Physical Exam, Plan or Assessment text box contains any of the following phrases:
    • Strep neg
    • Strep pos
    • Strep test neg
    • Strep test pos
    • Strep A neg
    • Strep A pos
    • Strep A test neg
    • Strep A test pos
  • An imported item's name contains any of the following phrases:
    • strep a test
    • strep test
    • streptococcus

Denominator

Outpatient, telephone, virtual encounter, or emergency department visits with a diagnosis of pharyngitis or tonsillitis from January 1st to December 28th of the measurement period and an antibiotic order on or three days after the episode date among patients 3 years or older.

Exclusions:

  • Exclude pharyngitis episodes when the patient is taking antibiotics in the 30 days prior to the episode date
  • Exclude Pharyngitis episodes when the patient had hospice care for any part of the measurement period.
  • Exclude Pharyngitis episodes when the patient had a competing co-morbid condition during the 12 months prior to or on the episode date.
  • Exclude Pharyngitis episodes where the patient had a competing diagnosis on or three days after the episode date
  • Exclude patients whose hospice or palliative care overlaps the measurement period:
    • Identified in the patient's Alerts and Directives, located in the demographic screen or the Summary Sheet, in the name, text or comments saved with that alert/directive. The Alert/Directive should include either of the following phrases:
      • palliative
      • hospice