• Measure 236 (NQF 0018): Controlling High Blood Pressure


    Updated March 2019.

    2019 additions in red.

     Reporting Options: 

    • IRIS Registry for manual data entry: groups and individuals
    • IRIS Registry EHR: groups and individuals
    • EHR through your vendor
    • Claims-based reporting: small practices only (group and individual)

    Measure Type: Intermediate Outcome

    NQS Domain: Effective Clinical Care

     

    Meaningful Measure Area: Management of Chronic Conditions

    Description: Percentage of patients 18 through 85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (< 140/90 mmHg) during the measurement period.

    Instructions: This measure is to be submitted a minimum of once per performance period for patients with hypertension seen during the performance period. The performance period for this measure is 12 months. The most recent quality code submitted will be used for performance calculation. This measure may be submitted by Merit-based Incentive Payment System (MIPS) eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding.

    NOTE: In reference to the numerator element, only blood pressure readings performed by a clinician in the provider office are acceptable for numerator compliance with this measure. Do not include blood pressure readings that meet the following criteria:

    • Blood pressure readings from the patient's home (including readings directly from monitoring devices).

    • Taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in

      diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests.

      If no blood pressure is recorded during the measurement period, the patient’s blood pressure is assumed “notcontrolled”.

    To Which Patients Does the Measure Apply?

    Denominator: Patients 18-85 years of age who had a diagnosis of essential hypertension within the first six months of the measurement period or any time prior to the measurement period

    1. Patient characteristics: Description located in “Instructions” (see above).
    2. Diagnosis codes (ICD-10-CM): Codes located in “Diagnosis Codes.”
    3. Procedure codes (CPT or HCPCS): Codes located in “CPT Codes.”

    Diagnosis Codes:

    Diagnosis for hypertension: I10

    CPT Codes:

    99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439

    Note: Eye codes 92002, 92004, 92012, and 92014 are not included in this measure.

    And Not Denominator Exclusion (Patient not eligible)

    Hospice services given to patient any time during the measurement period: G9740

    OR

    Documentation of end stage renal disease (ESRD), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period: G9231

    OR

    Patients age 65 or older in Institutional Special Needs Plans (SNP) or residing in long-term care with POS code 32, 33, 34, 54, or 56 any time during the measurement period: G9910

    How to Report the Measure

    Claims and Manual IRIS Registry Reporting

    Numerator: Patients whose blood pressure at the most recent visit is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period

    Numerator Instructions: To describe both systolic and diastolic blood pressure values, each must be submitted separately. If there are multiple blood pressures on the same date of service, use the lowest systolic and lowest diastolic blood pressure on that date as the representative blood pressure.

    In reference to the numerator element, only blood pressure readings performed by a MIPS eligible clinician in the provider office are acceptable for numerator compliance with this measure. Blood pressure readings from the patient's home (including readings directly from monitoring devices) are not acceptable.

    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, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading.

    Systolic pressure (Select one (1) code from this section):

    Numerator Options:

    Performance Met: G8752 Most recent systolic blood pressure < 140 mmHg

    Or

    Performance Not Met: G8753 Most recent systolic blood pressure ≥ 140 mmHg

    AND

    Diastolic pressure (Select one (1) code from this section):

    Performance Met: G8754 Most recent diastolic blood pressure < 90 mmHg

    Or

    Performance Not Met: G8755 Most recent diastolic blood pressure ≥ 90 mmHg

    Or

    Performance Not Met: G8756  No documentation of blood pressure measurement, reason not given

    IRIS Registry EHR Reporting

    Instructions: These are the required elements to be documented at least once a year to meet the measure performance requirements.

    • Diagnosis of essential hypertension
    • Less than 140/90mmHg blood pressure measurement at most recent visit

    Clinical Recommendation Statements:

    The United States Preventive Services Task Force (2007) recommends screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation.

    Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003): Treating systolic blood pressure and diastolic blood pressure to targets that are < 140/90 mmHg is associated with a decrease in cardiovascular disease complications.

    How CMS Scores Your Performance

    • If you report this measure for at least 50 percent of applicable patients during a reporting period, you will earn points based on the decile that corresponds to your performance rate. Not all measures offer points for every decile.
    • If you successfully report a measure for less than 50 percent of your patients, you will earn 3 points.
    • You can also earn bonus points because of the measure type and if you electronically report this measure (i.e., through an integrated EHR system).

    Benchmarks

    Decile/Points EHR (Including EHR-IRIS integration) IRIS Registry web portal (No EHR) Claims
    3 51.46 – 56.82 52.41 – 60.04 58.57 – 63.97
    4 56.83 – 60.94 60.05 – 65.57 63.98 – 68.82
    5 60.95 – 64.67 65.68 – 70.61 68.83 – 73.90
    6 64.68 – 68.17 70.62 – 76.82 73.91 – 78.56
    7 68.18 – 72.00 76.83 – 84.61 78.57 – 83.32
    8 72.01 – 76.25 84.62 – 93.39 83.33 – 88.31
    9 76.26 – 82.20 93.40 – 99.99 88.32 – 94.88
    10 >= 82.21 100 >= 94.89