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: CMS154FHIRAppropriateTxforURI

Official URL: https://madie.cms.gov/Library/CMS154FHIRAppropriateTxforURI Version: 1.0.000
Active as of 2025-07-25 Responsible: National Committee for Quality Assurance Computable Name: CMS154FHIRAppropriateTxforURI
Other Identifiers: https://madie.cms.gov/login#CMS154FHIRAppropriateTxforURI (use: official, )

CMS154FHIRAppropriateTxforURI

Metadata
Title CMS154FHIRAppropriateTxforURI
Version 1.0.000
Identifier CMS154FHIRAppropriateTxforURI
Steward (Publisher) National Committee for Quality Assurance
Description

CMS154FHIRAppropriateTxforURI
Type logic-library from http://terminology.hl7.org/CodeSystem/library-type
Parameter Name: Measurement Period
Use: In
Min Cardinality: 0
Max Cardinality: 1
Type: Period
Parameter Name: Patient
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: Resource
Parameter Name: SDE Ethnicity
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: Resource
Parameter Name: SDE Payer
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
Parameter Name: SDE Race
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: Resource
Parameter Name: SDE Sex
Use: Out
Min Cardinality: 0
Max Cardinality: 1
Type: Coding
Parameter Name: Qualifying Encounters
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
Parameter Name: Encounter with Upper Respiratory Infection
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
Parameter Name: Initial Population
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
Parameter Name: Encounters and Assessments with Hospice Patient
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
Parameter Name: Denominator
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
Parameter Name: Denominator Exclusions
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
Parameter Name: Numerator
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
Parameter Name: Stratification 1
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
Parameter Name: Stratification 2
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
Parameter Name: Stratification 3
Use: Out
Min Cardinality: 0
Max Cardinality: *
Type: Resource
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: Condition
Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis
Must Support Elements: code
Code Filter(s):
Path: code
ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1022
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: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1025
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: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1017
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: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1011
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: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1012
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: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.196.12.1001
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
Library Content
CQL Content 
library CMS154FHIRAppropriateTxforURI 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 Status version '1.15.000' called Status
include QICoreCommon version '4.0.000' called QICoreCommon
include Antibiotic version '1.11.000' called Antibiotic

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 Upper Respiratory Infection": '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 "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 "Upper Respiratory Infection": 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.102.12.1022'
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>

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 Upper Respiratory Infection" EncounterWithURI
    where AgeInMonthsAt(date from start of "Measurement Period") >= 3
    return EncounterWithURI

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

define "Denominator":
  "Initial Population"

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

define "Encounter with Upper Respiratory Infection":
  from
    "Qualifying Encounters" QualifyingEncounters,
    ( ( [ConditionEncounterDiagnosis: "Upper Respiratory Infection"] ).verified ( ) ) URI
    where URI.prevalenceInterval ( ) starts during day of QualifyingEncounters.period
      or URI.prevalenceInterval ( ) overlaps before QualifyingEncounters.period
    return QualifyingEncounters

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

define "Numerator":
  "Encounter with Upper Respiratory Infection" EncounterWithURI
    without ( ( [MedicationRequest: "Antibiotic Medications for Upper Respiratory Infection"] ).isMedicationOrder ( ) ) OrderedAntibiotic
      such that OrderedAntibiotic.authoredOn 3 days or less on or after start of EncounterWithURI.period
    return EncounterWithURI

define "Stratification 1":
  "Encounter with Upper Respiratory Infection" EncounterWithURI
    where AgeInMonthsAt(date from start of "Measurement Period") >= 3
      and AgeInYearsAt(date from start of "Measurement Period") <= 17
    return EncounterWithURI

define "Stratification 2":
  "Encounter with Upper Respiratory Infection" EncounterWithURI
    where AgeInYearsAt(date from start of "Measurement Period") in Interval[18, 64]
    return EncounterWithURI

define "Stratification 3":
  "Encounter with Upper Respiratory Infection" EncounterWithURI
    where AgeInYearsAt(date from start of "Measurement Period") >= 65
    return EncounterWithURI
ELM XML Content 
Encoded data (141676 characters)
ELM JSON Content 
Encoded data (273132 characters)
Generated using version 0.5.0 of the sample-content-ig Liquid templates