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Initial antibiotic selection for community-acquired pneumonia (CAP) in immunocompetent patients

CBE ID
0147
1.4 Project
Pulmonary and Critical Care
Endorsement Status
Endorsement Removed
1.1 New or Maintenance
Maintenance
Previous Endorsement Cycle
Full Year 2015
Is Under Review
No
1.3 Measure Description

Percentage of Immunocompetent patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines

    • 1.14 Numerator

      Pneumonia patients who received an initial antibiotic regimen (as specified under the Set Measure Identifier and description in Measure Information Form) consistent with current guidelines during the first 24 hours of their hospitalization.

    • 1.15 Denominator

      Pneumonia patients 18 years of age or older

      Table 3.1 Pneumonia (PN)
      ICD-9 Code Shortened Description
      481 PNEUMOCOCCAL PNEUMONIA
      482.0 K. PNEUMONIAE PNEUMONIA
      482.1 PSEUDOMONAL PNEUMONIA
      482.2 H.INFLUENZAE PNEUMONIA
      482.30 STREPTOCOCCAL PNEUMN NOS
      482.31 PNEUMONIA STRPTOCOCCUS A
      482.32 PNEUMONIA STRPTOCOCCUS B
      482.39 PNEUMONIA OTH STREP
      482.40 STAPHYLOCOCCAL PNEU NOS
      482.41 METH SUS PNEUM D/T STAPH
      482.42 METH RES PNEU D/T STAPH
      482.49 STAPH PNEUMONIA NEC
      482.82 PNEUMONIA E COLI
      482.83 PNEUMO OTH GRM-NEG BACT
      482.84 LEGIONNAIRES´ DISEASE
      482.89 PNEUMONIA OTH SPCF BACT
      482.9 BACTERIAL PNEUMONIA NOS
      483.0 PNEU MYCPLSM PNEUMONIAE
      483.1 PNEUMONIA D/T CHLAMYDIA
      483.8 PNEUMON OTH SPEC ORGNSM
      485 BRONCHOPNEUMONIA ORG NOS
      486 PNEUMONIA, ORGANISM NOS

      Table 3.2 Septicemia
      ICD-9 Code Shortened Description
      038.0 STREPTOCOCCAL SEPTICEMIA
      038.10 STAPHYLCOCC SEPTICEM NOS
      038.11 METH SUSC STAPH AUR SEPT
      038.12 MRSA SEPTICEMIA
      038.19 STAPHYLCOCC SEPTICEM NEC
      038.2 PNEUMOCOCCAL SEPTICEMIA
      038.3 ANAEROBIC SEPTICEMIA
      038.40 GRAM-NEG SEPTICEMIA NOS
      038.41 H. INFLUENAE SEPTICEMIA
      038.42 E COLI SEPTICEMIA
      038.43 PSEUDOMONAS SEPTICEMIA
      038.44 SERRATIA SEPTICEMIA
      038.49 GRAM-NEG SEPTICEMIA NEC
      038.8 SEPTICEMIA NEC
      038.9 SEPTICEMIA NOS
      995.91 SEPSIS
      995.92 SEVERE SEPSIS

      Table 3.3 Respiratory Failure
      ICD-9 Code Shortened Description
      518.81 ACUTE RESPIRATRY FAILURE
      518.84 ACUTE & CHRONC RESP FAIL

      Table 3.1 Pneumonia (PN)
      ICD-10 Code Shortened Description
      J 13 Pneumonia due to Streptococcus pneumoniae
      J 18.1 Lobar pneumonia, unspecified organism
      J 15.0 Pneumonia due to Klebsiella pneumoniae
      J 15.1 Pneumonia due to Pseudomonas
      J 14 Pneumonia due to Hemophilus influenzae
      J 15.4 Pneumonia due to other streptococci
      J 15.3 Pneumonia due to streptococcus, group B
      J 15.20 Pneumonia due to staphylococcus, unspecified
      J 15.21 Pneumonia due to staphylococcus aureus
      Z 16 Infection and drug resistant microorganisms
      J 15.29 Pneumonia due to other staphylococcus
      J 15.5 Pneumonia due to Escherichia coli
      J 15.6 Pneumonia due to other aerobic Gram-negative bacteria
      A 48.1 Legionnaires’ disease
      J 15.8 Pneumonia due to other specified bacteria
      J 15.9 Unspecified bacterial pneumonia
      J 15.7 Pneumonia due to Mycoplasma pneumoniae
      J 16.0 Chlamydial pneumonia
      J 16.8 Pneumonia due to other specified infectious organisms
      J 18.0 Bronchopneumonia, unspecified organism
      J 18.8 Other pneumonia, unspecified organism
      J 18.9 Pneumonia, unspecified organism
      J 17 Pneumonia in diseases classified elsewhere
      J 18.2 Hypostatic pneumonia, unspecified organism
      J 85.1 Abscess of lung with pneumonia

      Table 3.2 Septicemia
      ICD-10 Code Shortened Description
      A 40.0 Sepsis due to streptococcus, group A
      A 40.1 Sepsis due to streptococcus, group B
      A 40.3 Sepsis due to Streptococcus pneumoniae
      A 40.8 Other streptococcal sepsis
      A 40.9 Streptococcal sepsis, unspecified
      A 41.9 Sepsis unspecified
      A 41.2 Sepsis due to other unspecified specified staphylococcus
      A 41.0 Sepsis due to Staphylococcus aureus
      A 41.0 AND U80.1 Sepsis due to Staphylococcus aureus AND Methicillin-resistant staph aureus infection
      A 41.1 Sepsis due to other specified staphylococcus
      A 41.89 Other specified sepsis
      A 41.4 Sepsis due to anaerobes
      A 41.50 Gram-negative sepsis, unspecified
      A 41.3 Sepsis due to Hemophilus influenzae
      A 41.51 Sepsis due to Escherichia coli ( E coli)
      A 41.52 Sepsis due to pseudomonas
      A 41.53 Sepsis due to Serratia
      A 41.59 Other Gram-negative sepsis
      A 41.81 Sepsis due to Enterococcus
      A 42.7 Actinomycotic sepsis
      A 41.9 Sepsis, unspecified
      R65.20 Severe sepsis without septic shock
      R65.21 Severe sepsis with septic shock

      Table 3.3 Respiratory Failure
      ICD-10 Code Shortened Description
      J 96.0 Acute respiratory failure
      J 96.9 Respiratory failure, unspecified
      J 96.2 Acute and chronic respiratory failure
      J 96.1 Chronic respiratory failure
      J 80 Acute respiratory syndrome
      J 22 Unspecified acute lower respiratory infection
      J 98.8 Other specified respiratory disorders

    • Exclusions

      Patients less than 18 years of age

      Patients who have a length of stay greater than 120 days

      Patients with Cystic Fibrosis

      Patients who had no chest x-ray or CT scan that indicated abnormal findings within 24 hours prior to hospital arrival or anytime during the hospitalization


      Receiving comfort measures only documented the day of or the day after arrival

      Patients enrolled in a clinical trial

      Patients received as a transfer from the emergency/observation department of another hospital

      Patients received as a transfer from an ambulatory surgery center

      Patients received as a transfer from an inpatient or outpatient department of another hospital

      Patients who have no diagnosis of pneumonia either as the ED final diagnosis/impression or direct admission diagnosis/impression

      Patients who are Compromised as defined in data dictionary (i.e., documentation that the patient had (1) any of the following compromising conditions: HIV positive, AIDS, cystic fibrosis, systemic chemotherapy within last three months, systemic immunosuppressive therapy within the past three months, leukemia documented in the past three months, lymphoma documented in the past three months, radiation therapy in the past three months; With healthcare associated pneumonia as defined in data dictionary (i.e., presence of at least one of the following: (1) hospitalization within the last 90 calendar days; (2) residence in a nursing home or extended care facility for any amount of time within the last 90 days; (3) chronic dialysis within the last 30 days prior to this hospitalization; (4) wound care, tracheostomy care or ventilator care provided by a health care professional within the last 30 days) and abstraction guidelines

      Patients transferred/admitted to the ICU within 24 hours after arrival to this hospital with a beta-lactam allergy

      Patients who have a duration of stay less than or equal to one day

      Patients with another source of infection who did not receive an antibiotic regimen recommeneded for pneumonia but did receive antibiotics within the first 24 hours of hospitalization

    • Most Recent Endorsement Activity
      Measure Retired and Endorsement Removed Pulmonary and Critical Care Project 2015-2016
      Initial Endorsement
      Last Updated
      Removal Date
    • Steward
      Centers for Medicare & Medicaid Services
      Steward Organization POC Email
      [email protected]