The AAB measure evaluates the inappropriate use of antibiotics in adults age 18-64 with a diagnosis of acute bronchitis. The rationale is that the vast majority of cases of acute bronchitis are viral and do not require antibiotic therapy. This measure is aimed at improving antibiotic stewardship across the population – stemming the tide of antibiotic resistance in local communities and the nation and avoiding potential side effects and complications of antibiotic therapy in an individual patient when the treatment is not clearly indicated.

Precise diagnostic coding is essential for accurate performance on this measure. The new ICD-10 codes are mostly specific to viral bronchitis. There are two unspecified ICD-10 codes J20.8, J20.9. Please pay careful attention to the diagnostic codes to reflect the condition you are treating and use bacterial ICD-10 codes when appropriate.

Certain comorbid conditions that could influence your decision to prescribe antibiotic therapy for bronchitis are critical to document as well, since they will result in removal of the patient from the denominator in this measure and more appropriately reflect your clinical thought process. Here are some tips for clinical coding accuracy on this measure:

• Only utilize the code for acute bronchitis if the diagnosis is accurate/confirmed
• Remember to code for relevant comorbidities if and when you do prescribe antibiotics for bronchitis:

– HIV

– Malignant Neoplasm

– Emphysema

– COPD

– Cystic Fibrosis

– HIV Type 2

– Disorders of the Immune System

We also realize that pressure for antibiotic therapy may come from patients themselves. To assist you in educating your patients on the importance of antibiotic stewardship and the facts about viral versus bacterial processes, we would be happy to supply you with Rx pads from the Centers for Disease Control’s Get Smart campaign about antibiotics while supplies last. If you would like to receive these Rx pads, please contact Monica Broughton, MPH, quality management analyst, at (401) 459-1146 or monica.broughton@bcbsri.org. For the most up to date information on this campaign please visit www.cdc.gov/features/antibioticuse/index.html.