dQM QICore Content Implementation Guide
2025.0.0 - CI Build

dQM QICore Content Implementation Guide, published by cqframework. This guide is not an authorized publication; it is the continuous build for version 2025.0.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/dqm-content-qicore-2025/ and changes regularly. See the Directory of published versions

Library: CMS146FHIRApproTestPharyngitis

Official URL: https://madie.cms.gov/Library/CMS146FHIRApproTestPharyngitis Version: 1.0.000
Active as of 2025-07-25 Responsible: National Committee for Quality Assurance Computable Name: CMS146FHIRApproTestPharyngitis
Other Identifiers: https://madie.cms.gov/login#CMS146FHIRApproTestPharyngitis (use: official, )

CMS146FHIRApproTestPharyngitis

Metadata
Title CMS146FHIRApproTestPharyngitis
Version 1.0.000
Identifier CMS146FHIRApproTestPharyngitis
Steward (Publisher) National Committee for Quality Assurance
Description

CMS146FHIRApproTestPharyngitis
Type http://terminology.hl7.org/CodeSystem/library-type#logic-library
Data Requirement Type: Patient
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Preventive Care Services, Initial Office Visit, 0 to 17
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Preventive Care Services Individual Counseling
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Preventive Care Services Initial Office Visit, 18 and Up
Data Requirement Type: Encounter
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter
Must Support Elements: type
Code Filter(s):
Path: type
ValueSet: Preventive Care, Established Office Visit, 0 to 17
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: Acute Pharyngitis
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: Acute Tonsillitis
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: Comorbid Conditions for Respiratory Conditions
Data Requirement Type: MedicationRequest
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
Must Support Elements: medication
Code Filter(s):
Path: medication
ValueSet: Antibiotic Medications for Pharyngitis
Data Requirement Type: MedicationRequest
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest
Must Support Elements: medication.reference.value
Data Requirement Type: Medication
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication
Must Support Elements: id.value, code
Data Requirement Type: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: Competing Conditions for Respiratory Conditions
Data Requirement Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab
Must Support Elements: code, value
Code Filter(s):
Path: code
ValueSet: Group A Streptococcus Test
Data Requirement Type: Observation
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-lab
Must Support Elements: code, value, effective
Code Filter(s):
Path: code
ValueSet: Group A Streptococcus Test
Parameters
Name Use Card. Type Documentation
Measurement Period In 0..1 Period
Patient Out 0..1 Resource
SDE Ethnicity Out 0..1 Resource
SDE Payer Out 0..* Resource
SDE Race Out 0..1 Resource
SDE Sex Out 0..1 Coding
Qualifying Encounters Out 0..* Resource
Encounter With Antibiotic Ordered Within Three Days Out 0..* Resource
Pharyngitis or Tonsillitis Out 0..* Resource
Encounter With Pharyngitis or Tonsillitis With Antibiotic Out 0..* Resource
Initial Population Out 0..* Resource
Denominator Out 0..* Resource
Encounters and Assessments with Hospice Patient Out 0..* Resource
Denominator Exclusions Out 0..* Resource
Group A Streptococcus Lab Test With Result Out 0..* Resource
Numerator Out 0..* Resource
Stratification 1 Out 0..* Resource
Stratification 2 Out 0..* Resource
Stratification 3 Out 0..* Resource
Library Content
CQL Content 
library CMS146FHIRApproTestPharyngitis version '1.0.000'

using QICore version '6.0.0'

include FHIRHelpers version '4.4.000' called FHIRHelpers
include SupplementalDataElements version '5.1.000' called SDE
include Hospice version '6.18.000' called Hospice
include Antibiotic version '1.11.000' called Antibiotic
include Status version '1.15.000' called Status
include QICoreCommon version '4.0.000' called QICoreCommon

codesystem "CPT": 'http://www.ama-assn.org/go/cpt'

valueset "Acute Pharyngitis": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011'
valueset "Acute Tonsillitis": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012'
valueset "Antibiotic Medications for Pharyngitis": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001'
valueset "Comorbid Conditions for Respiratory Conditions": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1025'
valueset "Competing Conditions for Respiratory Conditions": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1017'
valueset "Emergency Department Evaluation and Management Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010'
valueset "Group A Streptococcus Test": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012'
valueset "Home Healthcare Services": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016'
valueset "Medical Disability Exam": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1073'
valueset "Office Visit": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001'
valueset "Outpatient Consultation": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008'
valueset "Preventive Care Services Established Office Visit, 18 and Up": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025'
valueset "Preventive Care Services Group Counseling": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1027'
valueset "Preventive Care Services Individual Counseling": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1026'
valueset "Preventive Care Services Initial Office Visit, 18 and Up": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023'
valueset "Preventive Care Services, Initial Office Visit, 0 to 17": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022'
valueset "Preventive Care, Established Office Visit, 0 to 17": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024'
valueset "Telephone Visits": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080'
valueset "Virtual Encounter": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089'

code "Unlisted preventive medicine service": '99429' from "CPT" display 'Unlisted preventive medicine service'

parameter "Measurement Period" Interval<DateTime>
  default Interval[@2026-01-01T00:00:00.000Z, @2027-01-01T00:00:00.000Z)

context Patient

define "SDE Ethnicity":
  SDE."SDE Ethnicity"

define "SDE Payer":
  SDE."SDE Payer"

define "SDE Race":
  SDE."SDE Race"

define "SDE Sex":
  SDE."SDE Sex"

define "Initial Population":
  "Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis
    where AgeInYearsAt(date from start of "Measurement Period") >= 3
    return EncounterWithPharyngitis

define "Encounter With Pharyngitis or Tonsillitis With Antibiotic":
  from
    "Encounter With Antibiotic Ordered Within Three Days" VisitWithAntibiotic,
    "Pharyngitis or Tonsillitis" AcutePharyngitisTonsillitis
    where AcutePharyngitisTonsillitis.prevalenceInterval ( ) starts during day of VisitWithAntibiotic.period
    return VisitWithAntibiotic

define "Pharyngitis or Tonsillitis":
  ( [ConditionEncounterDiagnosis: "Acute Pharyngitis"]
      union [ConditionEncounterDiagnosis: "Acute Tonsillitis"]
  ).verified ( )

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Encounters and Assessments with Hospice Patient"
    union Antibiotic."Encounter with Comorbid Condition History" ( "Encounter With Pharyngitis or Tonsillitis With Antibiotic", ( [ConditionEncounterDiagnosis: "Comorbid Conditions for Respiratory Conditions"] ).verified ( ) )
    union Antibiotic."Encounter with Antibiotic Medication History" ( "Encounter With Pharyngitis or Tonsillitis With Antibiotic", ( [MedicationRequest: "Antibiotic Medications for Pharyngitis"] ).isMedicationActive ( ) )
    union Antibiotic."Encounter with Competing Diagnosis History" ( "Encounter With Pharyngitis or Tonsillitis With Antibiotic", ( [ConditionEncounterDiagnosis: "Competing Conditions for Respiratory Conditions"] ).verified ( ) )

define "Encounter With Antibiotic Ordered Within Three Days":
  "Qualifying Encounters" EDOrAmbulatoryVisit
    with ( ( [MedicationRequest: "Antibiotic Medications for Pharyngitis"] ).isMedicationOrder ( ) ) AntibioticOrdered
      such that EDOrAmbulatoryVisit.period.toInterval ( ) starts 3 days or less on or before day of AntibioticOrdered.authoredOn

define "Encounters and Assessments with Hospice Patient":
  "Initial Population" EligibleEncounters
    where Hospice."Has Hospice Services"

define "Qualifying Encounters":
  ( ( [Encounter: "Emergency Department Evaluation and Management Visit"]
      union [Encounter: "Home Healthcare Services"]
      union [Encounter: "Medical Disability Exam"]
      union [Encounter: "Office Visit"]
      union [Encounter: "Telephone Visits"]
      union [Encounter: "Virtual Encounter"]
      union [Encounter: "Outpatient Consultation"]
      union [Encounter: "Preventive Care Services Established Office Visit, 18 and Up"]
      union [Encounter: "Preventive Care Services Group Counseling"]
      union ( [Encounter] E
          where exists ( ( E.type ) T
              where T ~ "Unlisted preventive medicine service"
          )
      )
      union [Encounter: "Preventive Care Services, Initial Office Visit, 0 to 17"]
      union [Encounter: "Preventive Care Services Individual Counseling"]
      union [Encounter: "Preventive Care Services Initial Office Visit, 18 and Up"]
      union [Encounter: "Preventive Care, Established Office Visit, 0 to 17"]
  ).isEncounterPerformed ( ) ) ValidEncounter
    where ValidEncounter.period ends during day of Interval[( start of "Measurement Period" ), ( end of "Measurement Period" ) - 3 days]

define "Numerator":
  from
    "Group A Streptococcus Lab Test With Result" GroupAStreptococcusTest,
    "Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis
    where GroupAStreptococcusTest.effective.toInterval ( ) starts during day of Interval[( end of EncounterWithPharyngitis.period ) - 3 days, ( end of EncounterWithPharyngitis.period ) + 3 days]
    return EncounterWithPharyngitis

define "Group A Streptococcus Lab Test With Result":
  ( ( [LaboratoryResultObservation: "Group A Streptococcus Test"] ).isLaboratoryTestPerformed ( ) ) GroupAStreptococcusTest
    where GroupAStreptococcusTest.value is not null

define "Stratification 1":
  "Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis
    where AgeInYearsAt(date from start of "Measurement Period") in Interval[3, 17]
    return EncounterWithPharyngitis

define "Stratification 2":
  "Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis
    where AgeInYearsAt(date from start of "Measurement Period") in Interval[18, 64]
    return EncounterWithPharyngitis

define "Stratification 3":
  "Encounter With Pharyngitis or Tonsillitis With Antibiotic" EncounterWithPharyngitis
    where AgeInYearsAt(date from start of "Measurement Period") >= 65
    return EncounterWithPharyngitis
ELM XML Content 
Encoded data
ELM JSON Content 
Encoded data
Citations and References
Dependency Description: Library FHIRHelpers
Resource: FHIRHelpers version: 4.4.000
Canonical URL: https://madie.cms.gov/Library/FHIRHelpers|4.4.000
Dependency Description: Library SDE
Resource: SupplementalDataElements version: 5.1.000
Canonical URL: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000
Dependency Description: Library Hospice
Resource: Hospice version: 6.18.000
Canonical URL: https://madie.cms.gov/Library/Hospice|6.18.000
Dependency Description: Library Antibiotic
Resource: Antibiotic version: 1.11.000
Canonical URL: https://madie.cms.gov/Library/Antibiotic|1.11.000
Dependency Description: Library Status
Resource: Status version: 1.15.000
Canonical URL: https://madie.cms.gov/Library/Status|1.15.000
Dependency Description: Library QICoreCommon
Resource: QICoreCommon version: 4.0.000
Canonical URL: https://madie.cms.gov/Library/QICoreCommon|4.0.000
Dependency Description: Code system CPT
Resource: Current Procedural Terminology (CPT®)
Canonical URL: http://www.ama-assn.org/go/cpt
Dependency Description: Value set Acute Pharyngitis
Resource: Acute Pharyngitis
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011
Dependency Description: Value set Acute Tonsillitis
Resource: Acute Tonsillitis
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012
Dependency Description: Value set Antibiotic Medications for Pharyngitis
Resource: Antibiotic Medications for Pharyngitis
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001
Dependency Description: Value set Comorbid Conditions for Respiratory Conditions
Resource: Comorbid Conditions for Respiratory Conditions
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1025
Dependency Description: Value set Competing Conditions for Respiratory Conditions
Resource: Competing Conditions for Respiratory Conditions
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1017
Dependency Description: Value set Emergency Department Evaluation and Management Visit
Resource: Emergency Department Evaluation and Management Visit
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1010
Dependency Description: Value set Group A Streptococcus Test
Resource: Group A Streptococcus Test
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1012
Dependency Description: Value set Home Healthcare Services
Resource: Home Healthcare Services
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1016
Dependency Description: Value set Medical Disability Exam
Resource: Medical Disability Exam
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1073
Dependency Description: Value set Office Visit
Resource: Office Visit
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1001
Dependency Description: Value set Outpatient Consultation
Resource: Outpatient Consultation
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1008
Dependency Description: Value set Preventive Care Services Established Office Visit, 18 and Up
Resource: Preventive Care Services Established Office Visit, 18 and Up
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1025
Dependency Description: Value set Preventive Care Services Group Counseling
Resource: Preventive Care Services Group Counseling
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1027
Dependency Description: Value set Preventive Care Services Individual Counseling
Resource: Preventive Care Services Individual Counseling
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1026
Dependency Description: Value set Preventive Care Services Initial Office Visit, 18 and Up
Resource: Preventive Care Services Initial Office Visit, 18 and Up
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1023
Dependency Description: Value set Preventive Care Services, Initial Office Visit, 0 to 17
Resource: Preventive Care Services, Initial Office Visit, 0 to 17
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1022
Dependency Description: Value set Preventive Care, Established Office Visit, 0 to 17
Resource: Preventive Care, Established Office Visit, 0 to 17
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1024
Dependency Description: Value set Telephone Visits
Resource: Telephone Visits
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1080
Dependency Description: Value set Virtual Encounter
Resource: Virtual Encounter
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1089
Generated using version 0.5.6 of the sample-content-ig Liquid templates