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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
317 0000 Process Yes Community / Population Health Claims

Measure Description

Percentage of patients aged 18 years and older seen during the submitting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated

Instructions

This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. Eligible clinicians who submit the measure must perform the blood pressure screening at the time of a qualifying visit by an eligible clinician and may not obtain measurements from external sources.


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. 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”.

NOTE: No notes related

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.

NUMERATOR

Patients who were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is pre-hypertensive or hypertensive

Definition

Blood Pressure (BP) Classification- BP is defined by four (4) BP reading classifications: Normal, PreHypertensive, First  Hypertensive, and Second Hypertensive Readings.

Recommended BP Follow-Up- The Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends BP screening intervals, lifestyle modifications and interventions based on the current BP reading as listed in the “Recommended Blood Pressure Follow- Up Interventions” listed below.
Recommended Lifestyle Modifications- The JNC 7 report outlines lifestyle modifications 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

Second Hypertensive Reading- Requires a BP reading of Systolic BP ≥ 140 mmHg OR Diastolic BP ≥ 90 mmHg during the current encounter AND a most recent BP reading within the last 12 months Systolic BP ≥ 140 mmHg OR Diastolic BP ≥ 90 mmHg
Second Hypertensive BP Reading Interventions- The JNC 7 report outlines BP follow-up interventions for a
second hypertensive BP reading and must include one or more of the following as indicated:

  • Anti-Hypertensive Pharmacologic Therapy
  • Laboratory Tests
  • Electrocardiogram (ECG)

Recommended Blood Pressure Follow-up Interventions-

  • Normal BP: No follow-up required for Systolic BP <120 mmHg AND Diastolic BP < 80 mmHg
  • Pre-Hypertensive BP: Follow-up with rescreen every year with systolic BP of 120 – 139 mmHg OR diastolic BP of 80 – 89 mmHg AND recommended lifestyle modifications OR referral to Alternate/Primary Care Provider
  • First Hypertensive BP Reading: Patients with one elevated reading of systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg:

    • Follow-up with rescreen > 1 day and < 4 weeks AND recommend lifestyle modifications OR referral to Alternative/Primary Care Provider
  • Second Hypertensive BP Reading: Patients with second elevated reading of systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg:

    • Follow-up with Recommended lifestyle modifications AND one or more of the Second Hypertensive Reading Interventions OR referral to Alternative/Primary Care Provider

*Not Eligible for High Blood Pressure Screening (Denominator Exclusion) –

  • Patient has an active diagnosis of hypertension starts prior to the current encounter

Numerator Quality-Data Coding Options

NUMERATOR 

Denominator Exception: G9745:
**Screening or Follow-Up for High Blood Pressure not Completed, Documented Reason

Documented reason for not screening or recommending a follow-up for high blood pressure

OR

Denominator Exclusion: G9744:
*Screening for High Blood Pressure not Documented, Patient not Eligible

Patient not eligible due to active diagnosis of hypertension

NUMERATOR 

Performance Met: G8783:
Normal Blood Pressure Reading Documented, Follow-Up not Required

Normal blood pressure reading documented, follow-up not required

NUMERATOR:

Performance Not Met: G8785:
Blood Pressure Reading not Documented, Reason not Given

Blood pressure reading not documented, reason not given

OR

Performance Not Met: G8952:
Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up not Documented, Reason not Given

Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given

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. If the blood pressure is prehypertensive (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 (G8783).

Denominator

All patients aged 18 years and older

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the PFS (Physician Fee Schedule). These non-covered services will not be counted in the denominator population for claims-based measures

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

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥ 18 years

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, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99318, 99324, 99325, 99326, 99327, 99328,
99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, *99385,
*99386,*99387,*99395,*99396,*99397 D7140, D7210, G0101, G0402, G0438, G0439

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

 

 

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