| Measure Type | High Priority Measure? | Collection Type(s) |
|---|---|---|
| Process | no | Medicare Part B Claims, eCQM, MIPS CQM |
Measure Description
Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is elevated or hypertensive.
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Instructions
This measure is to be submitted at each visit for patients seen during the measurement period. Merit-based Incentive Payment System (MIPS) eligible clinicians who submit the measure must perform the blood pressure screening at each patient visit by a MIPS eligible clinician and may not obtain measurements from external sources.
This measure may be submitted by MIPS eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. The intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated. Both the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures on the same date of service, use the most recent (last reading documented) as the representative blood pressure. The documented follow-up plan must be related to the current BP reading as indicated, example: “Patient referred to primary care provider for BP management”.
Measure Submission Type
Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.
Denominator
All patient visits for patients aged 18 years and older at the beginning of the measurement period
Definition:
Not Eligible for High Blood Pressure Screening (Denominator Exclusion) –
• Patient has an active diagnosis of hypertension starts prior to the current encounter
DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.
Denominator Criteria (Eligible Cases):
Patients aged ≥ 18 years at the beginning of the measurement period
AND
Patient encounter during the performance period (CPT or HCPCS): 90791, 90792, 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99281, 99282, 99283, 99284, 99285, 99215, 99236, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7251, G0101, G0402, G0438, G0439
WITHOUT
Telehealth Modifier: GQ, GT, 95, POS 02
AND NOT
DENOMINATOR EXCLUSION:
Patient not eligible due to active diagnosis of hypertension: G9744
Numerator
Patient visits where patients were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is elevated or hypertensive
NUMERATOR NOTE: Although the recommended screening interval for a normal BP reading is every 2 years, to meet the intent of this measure, BP screening and follow-up must be performed once per performance period. For patients with Normal blood pressure, a follow-up plan is not required (G8783). If the blood pressure is pre-hypertensive (SBP > 120 and <139 OR DBP >80 and <89) at a Primary Care Provider (PCP) encounter follow up as directed by the PCP would meet the intent of the measure (G8950).
Definitions:
Blood Pressure (BP) Classification – BP is defined by four (4) BP reading classifications: Normal, Elevated, First Hypertensive, and Second Hypertensive Readings
- Normal BP: Systolic BP (SBP) < 120 mmHg AND Diastolic BP (DBP) < 80 mmHg
- Elevated BP: SBP of 120-129 mmHg AND DBP < 80 mmHg
- First Hypertensive Reading: SBP of >= 130 mmHg OR DBP of >= 80 mmHg without a previous SBP of >= 130 mmHg OR DBP of >= 80 mmHg during the 12 months prior to the encounter
- Second Hypertensive Reading: Requires a SBP >= 130 mmHg OR DBP >= 80 mmHg during the current encounter AND a most recent BP reading within the last 12 months SBP >= 130 mmHg OR DBP >= 80 mmHg
Recommended BP Follow-Up – The 2017 Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults from the American College of Cardiology and American Heart Association (2017 Guideline) recommends BP screening and thresholds as defined under Blood Pressure Classifications and recommends interventions based on the current BP reading as listed in the “Recommended Blood Pressure Follow- Up” Table below.
Recommended Nonpharmacologic Interventions (Lifestyle Modifications) – The 2017 Guideline outlines nonpharmacologic interventions which must include one or more of the following as indicated:
- Weight Reduction
- Dietary Approaches to Stop Hypertension (DASH) Eating Plan
- Dietary Sodium Restriction
- Increased Physical Activity
- Moderation in alcohol (ETOH) Consumption
Recommended Blood Pressure Follow-Up Table
| BP Classification | Systolic BP mmHg | Diastolic BP mmHg | Recommended Follow-Up
(must include all indicated actions for each BP Classification) |
| Normal BP Reading | < 120 | AND < 80 | No Follow-Up required |
| Elevated BP Reading | 120-129 | AND < 80 | Rescreen BP in 2 to 6 months AND
recommended nonpharmacologic interventions OR Referral to Alternative/Primary Care Provider |
| First Hypertensive BP Reading | ≥ 130 | OR ≥ 80 | Rescreen BP > 1 day and < 4 weeks AND recommended lifestyle modifications
OR Referral to Alternative/Primary Care Provider |
| Second
Hypertensive BP Reading |
130-139 | OR 80-89 | Recommended nonpharmacologic intervention AND
reassessment in 2 to 6 months AND an order for laboratory test or ECG for hypertension Referral to Alternative/Primary Care Provider |
| Second
Hypertensive BP Reading |
>=140 | OR >=90 | Recommended nonpharmacologic intervention AND
BP-lowering medication AND reassessment within 4 weeks AND an order for laboratory test or ECG for hypertension Referral to Alternative/Primary Care Provider |
Patients with a Documented Reason for not Screening or no Follow-Up Plan for High Blood Pressure (Denominator Exceptions) –
- Documentation of medical reason(s) for not screening for high blood pressure (e.g., patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status).
- Documentation of patient reason(s) for not screening for blood pressure measurements or for not ordering an appropriate follow-up intervention if patient BP is elevated or hypertensive (e.g., patient refuses).
NUMERATOR NOTE: Although the recommended screening interval for a normal BP reading is every year, to meet the intent of this measure, BP screening and follow-up must be performed at every patient visit. For patients with Normal blood pressure, a follow-up plan is not required (G8783). Denominator Exception(s) are determined on the date of the denominator eligible encounter.
Numerator Options:
Performance Met:
Normal blood pressure reading documented, follow-up not required (G8783)
OR
Performance Met:
Elevated or Hypertensive blood pressure reading documented, AND the indicated follow-up is documented (G8950)
OR
Denominator Exception:
Documented reason for not screening or recommending a follow-up for high blood pressure (G9745).
OR
Performance Not Met:
Blood pressure reading not documented, reason not given (G8785)
OR
Performance Not Met:
Elevated or Hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given (G8952)