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Avoidance of Antibiotic Treatment for Acute Bronchitis/Bronchiolitis
EHP, Priority Partners, and USFHP. Members age 3 months and older.
Percentage of episodes for members ages 3 months and older with a diagnosis of acute bronchitis/bronchiolitis, who were not dispensed an antibiotic medication on or 3 days after the episode. Looks at episodes between July 1 of the year prior to the measurement year through June 30 of the measurement year. The measure is reported as an inverted rate: A higher rate indicates appropriate treatment (not prescribed an antibiotic).
Best Practice and Measure Tips
- Denied claims are not included when assessing the numerator, all claims (paid, suspended, pending and denied) must be included when identifying the eligible population.
- Avoid prescribing an antibiotic unless there is a bacterial etiology.
- When antibiotics are needed for a patient with acute bronchitis / bronchiolitis with comorbid conditions: submit codes on the same claim to remove member from measure.
- An episode will not count toward the measure denominator if the member was diagnosed with pharyngitis or a competing diagnosis on or 3 days after the episode date.
- Not exclusions for this HEDIS measure: asthma and diabetes diagnosis; Symptoms such as fever, cough and wheezing; tobacco use.
- CDC offers a number of materials and tools about antibiotic resistance, appropriate prescribing and use for common infections.
- Permission is not needed to print, copy, or distribute any materials. Visit the CDC website.
Required Exclusions: Hospice.
An episode for bronchitis/bronchiolitis will not count toward the measure denominator if the member was diagnosed with one of the following conditions during the 12 months prior to or on the event date.
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-C44.02, C44.90-C44.92, C44.99;
- additional codes apply.
Common differential diagnosis that remove members from measure due to presentation:
- Acute suppurative otitis media: H66.xxx
- Chronic sinusitis: J32.xxx
- Otitis media: H67.xxx
- Tonsillitis (chronic and hypertrophy): J35.xxx
- Mastoiditis (acute and chronic): H70.xxx
- Impetigo: L01.xxx
- Acute sinusitis: J01.xxx
- Cellulitis and lymphangitis: L03.xxx
- Pharyngitis: J02.xxx
- Urinary tract infection: N39
- Acute tonsillitis: J03.xxx
- Acute vaginitis: N76.xxx
- Pneumonia: J13.xx-J18.xx
To comply with this measure, the following antibiotics should not be dispensed upon diagnosis of acute bronchitis/bronchiolitis:
- Beta-lactamase inhibitors
- First-generation cephalosporins
- Fourth-generation cephalosporins
- Cefepime Ketolides
- Lincomycin derivatives
- Erythromycin ethylsuccinate
- Erythromycin lactobionate
- Erythromycin stearate
- Miscellaneous antibiotics
- Natural penicillins
- Penicillin G benzathine-procaine
- Penicillin G potassium
- Penicillin G procaine
- Penicillin G sodium
- Penicillin V potassium
- Penicillin G benzathine
- Penicillinase resistant penicillins
- Rifamycin derivatives
- Second-generation cephalosporins
- Third-generation cephalosporins
- Urinary anti-infectives
- Nitrofurantoin macrocrystals
- Nitrofurantoin macrocrystals-monohydrate