Avoidance of Antibiotics Treatment for Acute Bronchitis/Bronchiolitis (AAB)

The National Committee Quality Assurance (NCQA) develops and collects Healthcare Effectiveness Data and Information Set (HEDIS^®) measurements to set performance and drive improvement in quality‑of-care outcomes. The AAB measure is one of the priority measures that have many opportunities to optimize antibiotic prescribing.

The Federal Employee Program (FEP) is continuously working toward improving clinical quality of care and performance outcomes. To improve HEDIS AAB compliance, the FEP takes this opportunity to ask for your commitment to promote the appropriate use of antibiotic prescription in protecting your patients from harmful side effects and possible resistance to antibiotics over time.

According to the CDC, in U.S. doctors’ offices and emergency departments, at least 28% of antibiotic prescriptions each year are unnecessary, and an estimated 80 to 90% of antibiotic prescriptions occur in the outpatient setting, which makes improving antibiotic prescribing and use a national priority. The national guidelines recommend against prescribing antibiotics bronchitis/bronchiolitis for healthy people.

What is the HEDIS AAB measure?

The AAB measure looks at the percentage of episodes for members ages 3 months and older with a diagnosis of acute bronchitis/bronchiolitis that did not result in an antibiotic dispensing event.

If a patient is diagnosed with an acute bronchitis/acute bronchiolitis and medically requires an antibiotic prescription due to comorbid conditions at the time of the visit, it is important to document the comorbid conditions/diagnosis by using the appropriate ICD‑10-CM on the same visit claim which will remove the patient from the HEDIS AAB measure.

The table below lists the common ICD‑10-CM diagnosis codes for outpatient visits that trigger patients to be included in the HEDIS AAB measure:

Code	Description
J20.3, J20.4, J20.5, J20.6, J20.7, J20.8, J20.9	Acute bronchitis
J21.x, J21.0, J21.1, J21.8, J21.9	Acute bronchiolitis

Common ICD‑10-CM codes that exclude patients from the HEDIS AAB measure are:

Code	Description
J02.x	Acute pharyngitis
J03.x	Acute tonsillitis
H66.xxx	Suppurative otitis media
J01.xx	Acute sinusitis
J18.xx	Pneumonia
J32.xx	Chronic sinusitis
J35.xx	Chronic tonsillitis; hypertrophy tonsils
J39.x	Disease upper respiratory tract
L03.xx	Cellulitis/acute lymphangitis
N39.xx	UTI

Note: These lists are not all‑inclusive. This information is not about a change in policy but a reference to quality improvement activities.

The CDC is an excellent source for antibiotic information and awareness. In fact, the CDC leads in the Antibiotics Stewardship Training. We encourage you to take advantage of these continuing education opportunities:

• Free continuing education credit courses are available through the Stewardship Training Course: https://cdc.gov/antibiotic‑use/hcp/training/index.html
• Enjoy the CDC AAB online seminar. This session is approved for one AAFP credit. Use this link: https://bit.ly/improvingantibioticuse. Note: This site works best in Google Chrome.

Helpful tips:

• If a patient insists on an antibiotic:
• Refer to the illness as a chest cold rather than bronchitis; patients tend to associate the label with a less‑frequent need for antibiotics.
• Write a prescription for symptom relief, such as an over‑the-counter medicine.
• Reiterate the CDC’s recommendation that antibiotics do not work against viruses that cause most chest colds or bronchitis.
• Treat with antibiotics if the patient has a competing diagnosis listed above.
• Document accurately and use the correct ICD‑10-CM diagnosis codes.
• Use correct exclusion codes when appropriate.
• Maintain timely submission of claims and encounter data.