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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
236 0018 Intermediate Outcome Yes Effective Clinical Care Claims

Measure Description

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

Instructions

This measure is to be submitted 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 submitted 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 on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests.

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

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure-specific coding should be submitted on the claim(s) representing the eligible encounter.

The intent of the exclusion for individuals age 65 and older residing in long-term care facilities, including nursing homes, is to exclude individuals who may have limited life expectancy and increased frailty where the benefit of the process may not exceed the risks. This exclusion is not intended as a clinical recommendation regarding whether the measures process is inappropriate for specific populations, instead the exclusions allows clinicians to engage in shared decision making with patients about the benefits and risks of screening when an individual has limited life expectancy.

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

Definition

Numerator Instructions: To describe both systolic and diastolic blood pressure values, each must be submitted 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 Quality-Data Coding Options

NUMERATOR 

Denominator Exclusion: G9740:
Patient receiving Hospice Services, Patient Not Eligible:

(One G-code [G9904] is required on the claim form to submit documented circumstances when the action described in the numerator is not performed for medical reasons.)

Hospice services given to patient any time during the measurement period

OR

Denominator Exclusion: G9231:
Patient not Eligible for Recommended Blood Pressure Parameters for Documented Reasons:

Documentation of end stage renal disease (ESRD), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period

OR

Denominator Exclusion: G9910:
Patient age 65 or older in Institutional Special Needs Plans (SNP) or residing in long-term care facility, Patient Not Eligible:

Patients age 65 or older in Institutional Special NeedsPlans (SNP) or residing in long-term care with POS code32, 33, 34, 54, or 56 any time during the measurement period

NUMERATOR 

Systolic pressure (Select one (1) code from this section):

Performance Met: G8752:
Most Recent Blood Pressure Measurement Performed

Most recent systolic blood pressure < 140 mmHg

OR

Performance Not Met: G8753:

Most recent systolic blood pressure ≥ 140 mmHg

AND

Diastolic pressure (Select one (1) code from this section):

Performance Met: G8754:

Most recent diastolic blood pressure < 90 mmHg

OR

Performance Not Met: G8755:

Most recent diastolic blood pressure ≥ 90 mmHg

NUMERATOR:

Performance Not Met: G8756:
Blood Pressure Measurement not Documented, Reason not Given

No documentation of blood pressure measurement, reason not given

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

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

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

Patients18 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

 

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