A mother has a sick child and like all good mothers, wants comfort and care. And a prescription for antibiotics. BMJ Journals published a study that rated how many patients with upper respiratory infections (URI) prior to consultation with their physician expected a prescription for antibiotics. Evidence-based data does not support the use of antibiotics in the treatment of the common cold because they do not improve symptoms or shorten the course of the illness. Instead of putting away the prescription pad, use this one.

Offered by the CDC’s Be Antibiotics Aware campaign, the “Relief for common symptoms of colds and cough” prescription pad provides an alternative to unnecessary antibiotics. Get it through the CDC website here.

Measure up: HEDIS® guidelines for URI/Pharyngitis

URI measures the percentage of episodes for members 3 months of age and older with a URI diagnosis that did not result in an antibiotic dispensing event.

 

Appropriate Testing for Pharyngitis (CWP) evaluates members 3 years of age and older where the member was diagnosed with pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode.

 

Records and billing codes

URI: In the patient’s medical records, document results of all strep tests or refusal for testing. If antibiotics are prescribed for another condition, take care to associate the antibiotic with the appropriate diagnosis.

 

Description

CPT/HCPCS/ICD-10-CM

Pharyngitis

ICD-10-CM: J02.0, J02.8, J02.9, J03.00, J03.01, J03.80, J03.81, J03.90, J03.91

URI

ICD-10-CM: J00, J06.0, J06.9

Online assessments

CPT: 98970, 98971, 98972, 99421, 99422, 99423, 99457
HCPCS: G0071, G2010, G2012, G2061, G2062, G2063

Telephone visits

CPT: 98966, 98967, 98968, 99441, 99422, 99423

 

CWP: In the patient’s medical records, document results of all strep tests or refusal for testing. If antibiotics are prescribed for another condition, take care to associate the antibiotic with the appropriate diagnosis.

Description

CPT/HCPCS/ICD-10-CM

Pharyngitis

ICD-10-CM: J02.0, J02.8, J02.9, J03.00, J03.01, J03.80, J03.81, J03.90, J03.91

Group A streptococcal tests

CPT: 87070, 87071, 87081, 87430, 87650-87652, 87880
LOINC: 11268-0, 17656-0, 17898-8, 18481-2, 31971-5, 49610-9, 5036-9, 60489-2, 626-2, 6557-3, 6558-1, 6559-9, 68954-7, 78012-2

Online assessments

CPT: 98970, 98971, 98972, 99421, 99422, 99423, 99457
HCPCS: G0071, G2010, G2012, G2061, G2062, G2063

Telephone visits

CPT: 98966, 98967, 98968, 99441, 99422, 99423


1 BMJ Journals. Medical management of acute upper respiratory infections in an urban primary care out of hours facility: cross-sectional study of patient presentation and expectations. https://bmjopen.bmj.com/content/9/2/e025396

2 NCBI. Upper Respiratory Tract Infection. https://www.ncbi.nlm.nih.gov/books/NBK532961/  

 

1306-0921-PN-NE



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September 2021 Maine Provider News