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Appropriate Testing for Pharyngitis
EHP, Priority Partners, and USFHP. Members 3 years of age and older.
- Percentage of episodes for members ages 3 years and older where the member was diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode.
- A higher rate indicates appropriate testing and treatment.
- Report three age stratifications and total rate:
- 3–17 years.
- 18–64 years.
- 65 years and older.
- Total. The total is the sum of the age stratifications
Best Practice and Measure Tips
This measure addresses appropriate treatment for pharyngitis with a strep test and, if appropriate, prescription of an antibiotic within three days of the test. A pharyngitis diagnosis can be from an outpatient visit, online assessment, telehealth visit, emergency department or observation visit between July 1 of the year prior to the measurement year and June 30 of the measurement year.
Required Exclusion: Hospice.
12 months prior to or on the episode date diagnosis of one of the below:
- Malignant Neoplasms
- Malignant Neoplasms of the Skin
- Disorders of the Immune System
- Group A Strep Test
- CPT/CPT II 87070-71, 87081, 87430, 87650-52, 87880
- Pharyngitis ICD-10 Diagnosis
- J02.0, J02.8, J02.9, J03.00, J03.01, J03.80-81, J03.90-91
Exclusion Codes Value Set:
- J44.0, J44.1, J44.9
- J43.0, J43.1, J43.2, J43.8, J43.9
- Disorders of the immune system
- D80.0-D81.2, D81.4 , D81.6, D81.7, D81.89, D81.9, D82.0-D82.4, D82.8, D82.9
- B20, Z21
- Malignant neoplasms
- C00.0-C00.6, C00.8, C00.9, C01, C02.0-C02.4, C02.8, C02.9, C03.0, C03.1, C03.9, C04.0, C04.1, C04.8, C04.9, C05.0, C05.1, C05.2, C05.8, C05.9, C06.0, C06.1, C06.2, C06.80;
- Other malignant neoplasms of the skin:
- [C44.00] Unspecified malignant neoplasm of skin of lip
- [C44.01] Basal cell carcinoma of skin of lip
- [C44.02] Squamous cell carcinoma of skin of lip
- [C44.90] Unspecified malignant neoplasm of skin, unspecified
- [C44.91] Basal cell carcinoma of skin, unspecified
- [C44.92] Squamous cell carcinoma of skin, unspecified
- [C44.99] Other specified malignant neoplasm of skin, unspecified;
- additional codes apply.
The following antibiotic medications, in conjunction with a strep test, will meet compliance for this measure:
- Beta-lactamase inhibitors
- First generation cephalosporins
- Folate antagonist
- Lincomycin derivatives
- Erythromycin ethylsuccinate
- Erythromycin lactobionate
- Erythromycin stearate
- Natural penicillins
- Penicillin G potassium
- Penicillin G sodium
- Penicillin V potassium
- Penicillin G benzathine
- Penicillinase resistant penicillins
- Second generation cephalosporins
- Third generation cephalosporins