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Controlling High BP

Advantage MD, EHP, Priority Partners, and USFHP. Members 18-85 years of age

Members 18-85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (systolic and diastolic both LESS THAN 140/90 mm HG) during the measurement year.

  • Representative BP: The most recent (last BP of the year) BP reading during the measurement year on or after the second diagnosis of hypertension (system calculates).

If multiple BP readings are noted in the chart on the same date; the lowest systolic and lowest diastolic BP result will be used.

Best Practice and Measure Tips

  • Do not average BPs together.
  • 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, don’t round up the BP reading.
  • If initial BP is > 140/90, retake the member’s BP after they’ve had time to rest. If 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.

Acceptable Documentation:

  • BPs reported or taken by the member with a digital device and recorded in the medical record.
  • May obtain BP during telephone visits, e-visits or virtual check-ins. Have members take BP prior to visit to report during visit.
  • BP readings taken the same day member receives a common low-intensity or preventive procedure. Examples include, but aren’t limited to:
    • Eye exam with dilating agents
    • Injections (e.g., allergy, Depo Provera,® insulin, lidocaine, steroid, testosterone toradol, or vitamin B-12)
    • Intrauterine device (IUD) insertion
    • Tuberculosis (TB) test
    • Vaccinations
    • Wart or mole removal

Do not include BP readings:

  • Taken during an acute inpatient stay or an ED visits.
  • Taken on the same day as a diagnostic test or procedure that requires a medication regimen, change in diet or medication on or one day before the day of the test or procedure, with the exception of fasting blood tests.
  • Taken by the member using a non-digital device such as with a manual blood pressure cuff and a stethoscope.

Examples include, but are not limited to: Colonoscopy, Dialysis, infusions and chemotherapy, Nebulizer treatment with albuterol.

Measure Exclusions

Required Exclusions:

  • Palliative Care
  • Hospice
  • Fraility
  • Fraility and Advanced Illness
  • Living in Long Term Care

Optional Exclusions during measurement year:

  • Dialysis End-stage renal disease (ESRD) Kidney transplant Nephrectomy
  • Female members with a diagnosis of pregnancy
  • Non-acute inpatient admission

Measure Codes

  • Hypertension
    • ICD-10: I10
  • Outpatient Codes
    • CPT: 99201-99205, 99211-99215, 99241-99245, 99347 -99350, 99381-99387, 99391-99397, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99455, 99456, 99483, 99341-99345
    • HCPCS: G0402, G0438, G0439, G0463, T1015
  • Remote BP Monitoring
    • CPT: 93784, 93788, 93790, 99091
  • Diastolic Less than 80
    • CPT-CAT-II: 3078F
  • Diastolic 80-89
    • CPT-CAT-II: 3079F
  • Diastolic Greater than/Equal to 90
    • CPT-CAT-II: 3080F
  • Systolic Less than 130
    • CPT-CAT-II: 3074F
  • Systolic 131-140
    • CPT-CAT-II: 3075F
  • Systolic Greater than/Equal to 140
    • CPT-CAT-II: 3077F

Organizations that use CPT Category II codes to identify numerator compliance must use coding consistently throughout measurement year.