Monthly MIPS Tips

Appropriate Treatment for Upper Respiratory Infection (URI) 

(Measure 065) High Priority Measure 

CMS Guidelines 

Description: Percentage of episodes for patients 3 months of age and older with a diagnosis of upper respiratory infection (URI) that did not result in an antibiotic dispensing event 

Patient Eligibility: Patients aged 3 months of age and older (Pediatric) 

Diagnosis: Upper Respiratory Infection (URI) 

CMS Protocol: No Antibiotics 

Clinical Intent Antibiotic Stewardship: Reduce Inappropriate Use 

Clinical Recommendation: Most upper respiratory infections, also known as the common cold, are caused by viruses that require no antibiotic treatment. Too often, antibiotics are prescribed inappropriately, which can lead to antibiotic resistance (when antibiotics can no longer cure bacterial infections). 

Telemedicine: INCLUDED 

Documentation Criteria 

• Date of Onset

• Document any prescribed antibiotics, either prescription for the current visit or previous visits 30 days prior 

• If you choose to prescribe antibiotics, document the medical reason(s) why antibiotics were prescribed such as intestinal infections, pertussis, bacterial infection, etc. 

  • “Oral Antibiotic Rx due to concern for [medical reason] therefore patient was prescribed