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Johns Hopkins Health Plans

BPC-E - Blood Pressure Control for Patients With Hypertension

Product Lines:
Advantage MD, EHP, Priority Partners, and USFHP.

Measurement Period: January 1 - December 31

Description: 
The percentage of persons 18–85 years of age who had a diagnosis of hypertension (HTN) and whose most recent blood pressure (BP) was <140/90 mm Hg during the measurement period.

Stratifications: Report stratification by race and ethnicity.

Improvement Notation: Increased score indicates improvement.

Data Collection:

  • ECDS

Initial Population:

  • Measure Item Count: Person.
  • Age:18–85 years of age as of the last day of the measurement period.
  • Benefits: Medical.
  • Continuous Enrollment: The measurement period.
  • Allowable Gap: No more than one gap of ≤45 days during the measurement period. No gaps on the last day of the measurement period.

Denominator:
Persons with a diagnosis of hypertension. 
Persons who meet either of the following criteria:

  • At least two outpatient visits, telephone visits, e-visits or virtual check-ins on different dates of service with a diagnosis of hypertension on or between January 1 of the year prior to the measurement period and June 30 of the measurement period. 
  • At least one outpatient visit, telephone visit, e-visit or virtual check-in with a diagnosis of hypertension and at least one dispensed antihypertensive medication on or between January 1 of the year prior to the measurement period and June 30 of the measurement period.

Numerator:
Both a systolic and diastolic reading <140/90 mm Hg. 

The most recent systolic and diastolic BP readings taken during the measurement period on or after the second diagnosis of hypertension event

Persons are numerator compliant if the representative BP is <140/90 mm Hg. Persons are not compliant if the BP is ≥140/90 mm Hg, if there is no BP reading during the measurement period or if the reading is incomplete (e.g., the systolic or diastolic level is missing).

If multiple readings were recorded for a single date, use the lowest systolic and lowest diastolic BP on that date as the representative BP. The systolic and diastolic results do not need to be from the same reading.

Best Practice and Measure Tips

  • Ensure member has a BP monitor to use at home.
  • Since this is an electronic measure, data is only collected during the Prospective timeframe.
    • Submit on claims measure codes for systolic and diastolic blood pressure results.
  • Record and date all complete BPs in the medical records. If member is using a remote monitoring devise at home, be sure the results are in the member’s medical record.
  • Allow patient to rest for at least 5 minutes before taking the BP. Select appropriately sized BP cuff, and place cuff on bare arm.
  • Ensure patient is seated with feet on the floor, back supported and arm supported at heart level.
  • If office uses manual blood pressure cuffs, do not round up the BP reading.
  • If initial BP is equal to or > 140/90, retake the member’s BP after they’ve had time to rest. If BP remains elevated, ensure member follows up for BP check.
    • Since the last BP in the year is used, have member follow up for elevated BPs prior to the end of the year or have member report BP Readings from home if a visit is not possible. Be sure any member reported information is dated and information is available in the member’s medical record.
  • Implement process and procedures for staff to follow to accurately take BP reading. See American Medical Association (AMA) Control High BP best practices for recommendations and opportunities for improvement (https://www.ama-assn.org/system/files/2019-01/measure-accurately-best-practices.pdf).
  •  Educate member of the important of managing blood pressure. Ensure member has a BP monitor to use at home. Provide resource such as flayer and tracking log.
  • BPs cannot be used from inpatient stays, ER visits, or any BP taken the same day as a diagnostic test or procedure requiring a change in medication regiment change or a change in diet.

Measure Exclusions

Denominator Exclusions:

  • Persons receiving Palliative Care who had an encounter for Palliative Care any time during the measurement period.
  • Persons in hospice or using hospice services any time during the measurement period.
  • Persons who died any time during the measurement period.
  • Medicare enrollees, 66 years of age and older by the last day of the measurement period, in an institutional SNP (I-SNP) or living long-term in an institution (LTI).
  • Persons 66-80 years of age by the last day of the measurement period, with both frailty and advanced illness.
  • Persons 81 years of age or older by the last day of the measurement period, with frailty.
  • Persons with End-stage renal disease (ESRD) diagnosis or procedure: Dialysis, Total or Partial Nephrectomy, Kidney Transplant any time during the member’s history on or prior to the last day of the measurement period.
  • Persons with a diagnosis of pregnancy any time during the measurement period.
  • Non-acute inpatient admission during the measurement period.
    • This includes rehabilitation, nursing home, inpatient mental health, etc.
  • Laboratory claims (claims with POS code 81).

Numerator Exclusions:

  • Do not include CPT Category II codes (Systolic and Diastolic Result Value Set) with a modifier (CPT CAT II Modifier Value Set). 
  • Do not include BPs taken in an acute inpatient setting or ED visit.

Exclusion Codes

Dialysis Procedure

  • CPT: 90935, 90937, 90945, 90947, 90997, 90999, 99512
  • HCPCS: G0257, S9339
  • ICD-10-PCS: 3E1M39Z, 5A1D00Z, 5A1D60Z, 5A1D70Z, 5A1D80Z, 5A1D90Z

ESRD Diagnosis

  • ICD-10-CM:N18.5, N18.6
  • SNOMED CT US Edition: 46177005, 236434000, 236435004, 236436003, 433146000, 698810000, 704667004, 707324008, 712487000, 714152005, 714153000, 1332467008, 711000119100, 90761000119106, 90771000119100, 90791000119104, 96711000119105, 111411000119103, 120261000119101, 127991000119101, 128001000119105, 129161000119100, 140101000119109, 153851000119106, 153891000119101, 285011000119108, 285841000119104, 286371000119107, 368461000119103, 368471000119109, 434431000124103

History of Nephrectomy or Kidney Transplant

  • ICD-10-CM: Z90.5, Z94.0
  • SNOMED CT US Edition: 48994000, 161665007

Kidney Transplant

  • CPT: 50360, 50365, 50380
  • HCPCS: S2065
  • ICD-10-PCS: 0TY00Z0, 0TY00Z1, 0TY00Z2, 0TY10Z0, 0TY10Z1, 0TY10Z2
  • SNOMED CT US Edition: 52213001, 70536003, 175899003, 175901007, 175902000, 236138007, 313030004, 711411006, 711413009, 765478004, 765479007, 782655004, 6471000179103

Partial Nephrectomy

  • CPT: 50240
  • ICD-10-PCS: 0TB00ZZ, 0TB03ZZ, 0TB04ZZ, 0TB07ZZ, 0TB08ZZ, 0TB10ZZ, 0TB13ZZ, 0TB14ZZ, 0TB17ZZ, 0TB18ZZ
  • SNOMED CT US Edition: 48994000, 49780003, 51870000, 58367002, 81516001, 85250002, 88994001, 149579003, 149581001, 149584009, 175908001, 175909009, 175910004, 175916005, 175917001, 175918006, 175919003, 175920009, 236140002, 287729007, 289754003, 290691008, 439739008, 446894005, 699719001, 699720007, 708929007, 1119317007, 1119318002, 1119319005, 1119320004

Total Nephrectomy

  • CPT: 50220, 50225, 50230, 50234, 50236, 50340, 50370, 50543, 50545, 50546, 50548
  • ICD-10-PCS: 0TT00Z0, 0TT00Z1, 0TT00Z2, 0TT00ZZ, 0TT04ZG, 0TT04ZZ, 0TT10Z0, 0TT10Z1, 0TT10Z2, 0TT10ZZ, 0TT14ZG, 0TT14ZZ, 0TT20ZZ, 0TT24ZG, 0TT24ZZ
  • SNOMED CT US Edition: 1866009, 12976005, 48643009, 48994000, 58367002, 85250002, 88930008, 88994001, 116033007, 116166009, 149579003, 149583003, 149584009, 175905003, 175906002, 175909009, 175910004, 175911000, 175914008, 175915009, 265550007, 284348003, 287729007, 289754003, 290691008, 361249003, 439235001, 439964001, 440446009, 442919002, 443869003, 444083005, 446296004, 446990000, 447527008, 447531002, 698869007, 699719001, 699720007, 708908003, 712998006, 714031000, 722149000, 765472003, 765473008, 1017216005, 1017217001, 1017218006, 1017219003, 1289993008, 6561000179108

Nonacute Inpatient Stay

  • UBREV: 0022, 0024, 0118, 0128, 0138, 0148, 0158, 0190, 0191, 0192, 0193, 0194, 0199, 0524, 0525, 0550, 0551, 0552, 0559, 0660, 0661, 0662, 0663, 0669, 1000, 1001, 1002
  • UBTOB: 0180, 0181, 0182, 0183, 0184, 0185, 0187, 0188, 0210, 0211, 0212, 0213, 0214, 0215, 0217, 0218, 0220, 0221, 0222, 0223, 0224, 0225, 0227, 0228, 0280, 0281, 0282, 0283, 0284, 0285, 0287, 0288, 0289, 0650, 0651, 0652, 0653, 0654, 0655, 0657, 0658, 0660, 0661, 0662, 0663, 0664, 0665, 0667, 0668, 0860, 0861, 0862, 0863, 0864, 0865, 0867, 0868, 018F, 018G, 018H, 018I, 018J, 018K, 018M, 018O, 018X, 018Y, 018Z, 021F, 021G, 021H, 021I, 021J, 021K, 021M, 021O, 021X, 021Y, 021Z, 022F, 022G, 022H, 022I, 022J, 022K, 022M, 022O, 022X, 022Y, 022Z, 028F, 028G, 028H, 028I, 028J, 028K, 028M, 028O, 028X, 028Y, 028Z, 065F, 065G, 065H, 065I, 065J, 065K, 065M, 065O, 065X, 065Y, 065Z, 066F, 066G, 066H, 066I, 066J, 066K, 066M, 066O, 066X, 066Y, 066Z, 086F, 086G, 086H, 086I, 086J, 086K, 086M, 086O, 086X, 086Y, 086Z

Pregnancy 

  • ICD-10-CM Maternal conditions: O00-O9A.52
  • ICD-10-CM Encounter: Z03.71, Z03.72, Z03.73, Z03.74, Z03.75, Z03.79, Z33.1, Z33.2, Z33.3, Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, Z36.0, Z36.1, Z36.2, Z36.3, Z36.4, Z36.5, Z36.81, Z36.82, Z36.83, Z36.84, Z36.85, Z36.86, Z36.87, Z36.88, Z36.89, Z36.8A, Z36.9 
  • SNOMED CT US: 199305006, 199050003, 10750801000119102, 703309000, 300571009, 366323009, 428567001, 428930004, 429715006, 313180007, 428566005, 313178001, 428058009, 433601000124106, 441924001, 417570003, 11687002, 75022004, 46894009, 40801000119106, 10753491000119101, 237285000, 199141002, 77376005, 34165000, 724485008, 300573007, 300572002, 416402001, 609516006, 609519004, 86081009, 27152008, 87621000, 33370009, 1142097006, 80224003, 1142048002, 10751701000119102, 472699005*

*Please note that not all ICD-10-CM and SNOMED CT US Edition codes are listed here. For access to the complete set of codes related to Pregnancy Value Set, contact your Provider Engagement Liaison or email [email protected].

Measure Codes

Systolic Blood Pressure

  • Systolic Less Than 140 CPT-CAT-II: 3074F (<130 mm Hg), 3075F (130-139 mm Hg)
  • Systolic Greater Than or Equal to 140 CPT-CAT-II: 3077F
  • LOINC: 8459-0, 8480-6, 8508-4, 8546-4, 8547-2, 75997-7

Diastolic Blood Pressure

  • Diastolic Less Than 90 CPT-CAT-II: 3078F (<80 mm Hg), 3079F (80-89 mm Hg)
  • Diastolic Greater Than or Equal to 90 CPT-CAT-II: 3080F
  • LOINC: 8453-3, 8462-4, 8496-2, 8514-2, 8515-9, 75995-1