CMS 165v11: Controlling High Blood Pressure

Measure: Percentage of patients 18-85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of 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 by the end of the measurement period who had a visit and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of 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
  • Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period
  • Patients with a diagnosis of pregnancy during the measurement period
  • Patients in hospice care for any part of the measurement period
  • Patients receiving palliative care for any part of the measurement period
  • Patients 66 and older by the end of the measurement period who are living long term in a nursing home any time on or before the end of the measurement period
  • Patients 66-80 by the end of the measurement period with an indication of frailty for any part of the measurement period who also meet any of the following advanced illness criteria:
    • Advanced illness with two outpatient encounters during the measurement period or the year prior
    • OR advanced illness with one inpatient encounter during the measurement period or the year prior
    • OR taking dementia medications during the measurement period or the year prior
  • Patients 81 and older by the end of the measurement period with an indication of frailty for any part of the measurement period

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

  • Age is 18 years to 85 years at the end of the Measurement Period

    AND

  • Have an active diagnosis of essential hypertension at the start of the Measurement Period 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

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, 98969, 98970, 98971, 98972, 99421, 99422, 99423, 99458, 98966, 98967, 98968, 99441, 99442, 99443

HCPCS: G0438, G0439, G0071, G2010, G2012, G2061, G2062, G2063

The patient must have an active diagnosis of essential hypertension at the start of the Measurement Period or be diagnosed with essential hypertension within 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, kidney transplant recipient, 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 for any part of the Measurement Period
  • Is receiving palliative care for any part of the Measurement Period
  • Age is ≥ 66 at the end of the Measurement Period and are living long term in a nursing home any time on or before the end of the Measurement Period
  • Age is ≥ 66 at the end of the Measurement Period and has evidence of frailty and advanced illness
  • Age is ≥ 81 at the end of the measurement period with an indication of frailty for any part of the measurement period

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

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: 90947, 90945, 90940, 90937, 90935

HCPCS: G0257

Kidney Transplant

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

HCPCS: S2065

ESRD Monthly Outpatient Services

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

CPT: 99377, 99378

HCPCS: G0182

Order Status must be marked as Pending or Complete.

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

HCPCS: G9996, G9473, G9474, G9475, G9476, G9477, G9478, G9479, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, Q5010, S9126, T2042, T2043, T2044, T2045, T2046

Order Status must be marked as Complete.

Palliative care services can be documented using the FACIT-Pal Questionnaire flowsheet, as an order, or as a diagnosis.

  1. Go to Encounter > Flowsheets/Labs > Standard or Chart > Flowsheets/Labs > Standard

  2. Click Add New Flowsheet

  3. Select the FACIT-Pal Questionnaire flowsheet and click Add

  4. Click Add Column

  5. Populate the patient's responses to the questions as appropriate

  6. Click OK to save

Go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

HCPCS: G9054, M1017

Order Status must be marked as Complete.

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis code for palliative care is:

ICD-10: Z51.5

To document a nursing home stay:

  1. Go to Chart > Demographics > Patient Info

  2. Click Update

  3. Click Additional Info tab

  4. Populate the Date field in the Pop. Info section

  5. Select Patient lives in nursing home for Housing Status

  6. Click Save

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
  • 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 patient's use of a frailty device:

  1. Go to Encounter > Flowsheets/Labs > Standard or Chart > Flowsheets/Labs > Standard
  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 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
    • Encounters must have different dates of service
    • 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 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/ec/2023/cms165v11

 

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