2017 MIPS Measure #236: Controlling High Blood Pressure

Valid Data Submission Method(s) Measure Type High Priority Measure? NQS Domain Specialty Measure Sets
Claims, EHR, CMS Web Interface, Registry Intermediate Outcome Yes Effective Clinical Care Internal Medicine, Cardiology, Obstetrics/Gynecology, Preventive Medicine, Thoracic Surgery, Vascular Surgery, General Practice/Family Medicine

Measure Description

Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period

Instruction

This measure is to be reported a minimum of once per performance period for patients with hypertension seen during the performance period. The performance period for this measure is 12 months. The most recent quality code submitted will be used for performance calculation. This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

NOTE: In reference to the numerator element, only blood pressure readings performed by a clinician in the provider office are acceptable for numerator compliance with this measure. Do not include blood pressure readings that meet the following criteria:

  • Blood pressure readings from the patient’s home (including readings directly from monitoring devices).
  • Taken during an outpatient visit which was for the sole purpose of having a diagnostic test or surgical
    procedure performed (e.g., sigmoidoscopy, removal of a mole).
  • Obtained the same day as a major diagnostic or surgical procedure (e.g., stress test, administration of IV
    contrast for a radiology procedure, endoscopy)

If no blood pressure is recorded during the measurement period, the patient’s blood pressure is assumed “not
controlled”.

Denominator

Patients 18-85 years of age who had a diagnosis of essential hypertension within the first six months of the measurement period or any time prior to the measurement period

Denominator Criteria (Eligible Cases):
Patients 18 to 85 years of age on date of encounter
AND
Diagnosis for hypertension (ICD-10-CM): I10
AND
Patient encounter during performance period (CPT or HCPCS): 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439
AND NOT
DENOMINATOR EXCLUSIONS:
Hospice services given to patient any time during the measurement period: G9740
OR
Documentation of end stage renal disease (ESRD), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period: G9231

Numerator

Patients whose blood pressure at the most recent visit is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period

Numerator Instructions: To describe both systolic and diastolic blood pressure values, each must be reported separately. If there are multiple blood pressures on the same date of service, use the lowest systolic and lowest diastolic blood pressure on that date as the representative blood pressure.

NUMERATOR NOTE: In reference to the numerator element, only blood pressure readings performed by an eligible clinician in the provider office are acceptable for numerator compliance with this measure. Blood pressure readings from the patient’s home (including readings directly from monitoring devices) are not acceptable.
If no blood pressure is recorded during the measurement period, the patient’s blood pressure is assumed “not controlled.”

If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading.

Numerator Options:
Performance Met: Most recent systolic blood pressure < 140 mmHg (G8752)
OR
Performance Not Met: Most recent systolic blood pressure ≥ 140 mmHg (G8753)
AND
Performance Met: Most recent diastolic blood pressure < 90 mmHg (G8754)
OR
Performance Not Met: Most recent diastolic blood pressure ≥ 90 mmHg (G8755)
OR
Performance Not Met: No documentation of blood pressure measurement, reason not given (G8756)

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