CMS 165v6: Controlling High Blood Pressure

Patients who meet the following criteria will be included in the denominator:

• Age must be ≥ 18 years and < 85 years at the beginning of the Measurement Period

  AND

• Must have an existing diagnosis of essential hypertension or be diagnosed with essential hypertension within the first six months of the Measurement Period

  AND

• Must have at least one encounter during the Measurement Period finalized by the EC/EP

Encounter Codes Eligible for Denominator

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385, 99386, 99387, 99395, 99396, 99397, 99221, 99222, 99223, 99231, 99232, 99233, 99241, 99242, 99243, 99244, 99245, 99281, 99282, 99283, 99284, 99285, 99305, 99306, 99307, 99308, 99309, 99310, 99251, 99252, 99253, 99254, 99255, 99381, 99382, 99383, 99384, 99024, 99391, 99392, 99393, 99394, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

HCPCS: G0402, G0438, G0439

Diagnosis Codes Eligible for Denominator

Diagnoses are documented in the Assessment tab of an encounter.

ICD-10: I10

ICD-9: 401.0, 401.1, 401.9

A patient will be excluded from this measure if they meet any of the following conditions:

• Have an active diagnosis of pregnancy, end stage renal disease, or chronic kidney disease, stage 5 during the Measurement Period
• Received services related to kidney disease or a kidney transplant before or during the Measurement Period
• Were in hospice care during the measurement year

Diagnosis

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for this exclusion can be located here.

Encounter Codes Eligible for Denominator Exclusion

CPT: 90951, 90952, 90953, 90954, 90955, 90956, 90957, 90958, 90959, 90960, 90961, 90962, 90963, 90964, 90965, 90966, 90967, 90968, 90969, 90970, 90989, 90993, 90997, 90999, 99512

Procedure Codes Eligible for Denominator Exclusion

To document the performance of a services received related to kidney disease or a kidney transplant, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below. Order Status must be marked as Complete in order to count as an exclusion.

Dialysis Services

CPT: 90920, 90947, 90945, 90940, 90937, 90935, 90925, 90924, 90921

HCPCS: G0257

Vascular Access for Dialysis

CPT: 36147, 36833, 36832, 36831, 36821, 36820, 36819, 36818, 36815, 36810, 36800, 36148

Kidney Transplant

CPT: 50340, 50380, 50370, 50365, 50360

HCPCS: S2065

Hospice Care Services

To document hospice care services as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

SNOMED CT: 385763009, 385765002

Order Status must be marked as Complete.

Note

SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab.

A patient will be counted in the numerator if they have a documented blood pressure reading of

< 140/90 during their most recent encounter during the Measurement Period.

• 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, the lowest reading will be counted toward the numerator

Documenting Blood Pressure

Blood pressure is documented in the Vitals tab of an encounter.

To document blood pressure, go to Encounter > Vitals > click Add/Retake Vitals

https://ecqi.healthit.gov/ecqm/ep/2018/cms165v6