CMS 165v8: Controlling High Blood Pressure

Measure: Percentage of patients 18-85 years of age who had a diagnosis of hypertension overlapping the measurement period and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period
Measure Type High Priority Measure Scoring
Outcome Yes A higher percentage indicates better quality
Denominator Patients 18-85 years of age who had a visit and diagnosis of essential hypertension overlapping the measurement period
Numerator Patients whose most recent blood pressure is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period
Denominator Exceptions None
Denominator Exclusions

Exclude patients:

  • With evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period
  • With a diagnosis of pregnancy during the measurement period
  • Whose hospice care overlaps the measurement period
  • Patients 66 and older who are living long term in an institution for more than 90 days during the measurement period
  • Patients 66 and older with advanced illness and frailty because it is unlikely that patients will benefit from the services being measured

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

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

    AND

  • Have an existing diagnosis of essential hypertension or were diagnosed with essential hypertension within the first six months of the Measurement Period

    AND

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

CPT: 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99395, 99396, 99397, 99385, 99386, 99387, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350

HCPCS: G0438, G0439

The patient must have an active diagnosis of essential hypertension during the first six months of the Measurement Period. Diagnoses are documented in the Assessment tab of an encounter.

The eligible diagnosis codes for essential hypertension are:

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:

  • Has 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
  • Is in hospice care during the Measurement Period
  • Age is ≥ 65 at the start of the Measurement Period and has spent more than 90 days during the Measurement Period living in long term care
  • Age is ≥ 65 at the start of the Measurement Period and has evidence of advanced illness
  • Age is ≥ 65 at the start of the Measurement Period and has evidence of frailty

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

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,

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: 50300, 50320, 50340, 50380, 50370, 50365, 50360

HCPCS: S2065

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 Pending or Complete.

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

To document days spent in long term care:

  1. Go to Chart > Admissions and click Add
  2. Select a Place of Service
  3. Optional: select a Facility
  4. Populate the Admit Date
  5. Optional: populate the Discharge Date
  6. Click OK

The cumulative total of the patient's admission events during the Measurement Period must be greater than 90 days.

If the admissions event does not have a Discharge Date, the length of stay will be calculated with a discharge date of the Reporting Period end date or the Measurement Period end date, whichever occurs first.

A patient has evidence of advanced illness if they meet any of the following criteria:

  • Had an inpatient encounter with an active diagnosis of Advanced Illness during the Measurement Period or in the year prior
  • Had 2 or more outpatient encounters with an active diagnosis of Advanced Illness during the Measurement Period or in the year prior
    • Diagnosis must be active during all eligible encounters
  • Was prescribed medication for dementia during the Measurement Period or in the year prior

"Advanced illness" refers to a wide range of conditions and includes diseases such as Alzheimer's disease, cancer, and heart failure.

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

CPT: 99221, 99222, 99223, 99231, 99232, 99233, 99238, 99239, 99251, 99252, 99253, 99254, 99255, 99291

CPT: 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99381, 99382, 99383, 99384, 99385, 99386, 99387, 99391, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99455, 99456, 99483, 99217, 99218, 99219, 99220, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337

HCPCS: G0402, G0438, G0439, G0463, T1015

To prescribe a medication, go to Encounter > Medications > Manage/Prescribe Meds > New Prescription. A comprehensive list of eligible dementia medications can be located here.

A patient has evidence of frailty if they meet any of the following criteria:

  • Has an active diagnosis of Frailty during the Measurement Period
  • Has an active diagnosis of Frailty Symptom during the Measurement Period
  • Has an order for a frailty device during the Measurement Period
  • Is using a frailty device during the Measurement Period
  • Has a frailty encounter during the Measurement Period

"Frailty" refers to a range of conditions that includes falls and problems affecting mobility.

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

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis codes for frailty symptoms are:

ICD-10: R26.0, R26.1, R26.2, R26.89, R26.9, R41.81, R53.1, R53.81, R53.83, R54, R62.7, R63.4, R63.6, R64

To document the order of a frailty device, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add an order. Order Status must be marked as Pending or Complete.

A comprehensive list of eligible frailty devices can be located here.

To document the patient's use of a frailty device:

  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
  2. Click Add New Flowsheet
  3. Select the Frailty Device flowsheet and click Add
  4. Click Add Column
  5. Select a Device and the type (Value) of device
  6. Populate a usage Start Date for the device
  7. Optional: populate a usage Stop Date for the device
    1. The Stop Date cannot occur prior to the start of the Measurement Period
  8. Optional: populate a Reason for use of the device
  9. Click OK to save

CPT: 99504, 99509

HCPCS: G0162, G0299, G0300, G0493, G0494, S0271, S0311, S9123, S9124, T1000, T1001, T1002, T1003, T1004, T1005, T1019, T1020, T1021, T1022, T1030, T1031

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.

  • Blood pressure readings taken during an emergency department visit will not count toward the numerator
  • 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 systolic and the lowest diastolic reading will be counted toward the numerator

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/2020/cms165v8

 

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