• Measure 317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented


    Updated January 2018.

    Reporting Options: 

    • IRIS Registry manual entry: groups and individuals
    • EHR through your vendor (if offered): groups and individuals
    • Claims-based reporting: individuals only

    Measure Type: Process

    Instructions: This measure is to be reported a minimum of once per performance period for patients, aged 18 years and older, who were screened for high blood pressure and a recommended follow-up plan is documented based on the current blood pressure reading as indicated.

    Eligible clinicians who submit the measure must perform the blood pressure screening at the time of a qualifying visit and may not obtain measurements from external sources.

    This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. The intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated.

    Both the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures on the same date of service, use the most recent (last reading documented) as the representative blood pressure.

    The documented follow-up plan must be related to the current BP reading as indicated, example: “Patient referred to primary care provider for BP management.”

    Definitions:

    Blood pressure classification - BP is defined by four (4) BP reading classifications: Normal, pre-hypertensive, first hypertensive, and second hypertensive readings

    Recommended BP follow-up - The Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends BP screening intervals, lifestyle modifications and interventions based on the current BP reading as listed in the “Recommended Blood Pressure Follow- Up Interventions” listed below

    Recommended lifestyle modifications - The JNC 7 report outlines lifestyle modifications which must include one or more of the following as indicated:

    • Weight reduction;
    • Dietary approaches to stop hypertension (DASH) eating plan;
    • Dietary sodium restriction;
    • Increased physical activity
    • Moderation in alcohol (ETOH) consumption

    Second hypertensive reading - Requires a BP reading of systolic BP ≥ 140 mmHg OR diastolic BP ≥ 90 mmHg during the current encounter and a most recent BP reading within the last 12 months systolic BP ≥ 140 mmHg OR diastolic BP ≥ 90 mmHg

    Second hypertensive BP reading interventions - The JNC 7 report outlines BP follow-up interventions for a second hypertensive BP reading and must include one or more of the following as indicated:

    • Anti-hypertensive pharmacologic therapy
    • Laboratory tests
    • Electrocardiogram

    Recommended blood pressure follow-up interventions –

    • Normal BP: No follow-up required for systolic BP <120 mmHg and diastolic BP < 80 mmHg
    • Pre-hypertensive BP: Follow-up with rescreen every year with systolic BP of 120 – 139 mmHg or diastolic BP of 80 – 89 mmHg and recommended lifestyle modifications or referral to alternate/primary care provider
    • First hypertensive BP reading: Patients with one elevated reading of systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg:
      • Follow-up with rescreen > 1 day and < 4 weeks and recommend lifestyle modifications or referral to alternative/primary care provider
    • Second hypertensive BP reading: Patients with second elevated reading of systolic BP ≥ 140 mmHg OR diastolic BP ≥ 90 mmHg:
      • Follow-up with recommended lifestyle modifications and one or more of the second hypertensive reading interventions or referral to alternative/primary care provider

    Recommended Blood Pressure Follow-Up Table

    BP Classification Systolic BP mmHg Diastolic BP mmHg Recommended Follow-Up (must include all
    indicated actions for each BP classification)
     
    Normal BP reading < 120 and < 80 No Follow-Up required
    Pre-hypertensive BP reading ≥ 120 AND ≤ 139 or ≥ 80 AND ≤ 89 Rescreen BP within a minimum of 1 year
    and
    Recommend lifestyle modifications
    or
    Referral to alternative/primary care provider
    First hypertensive BP reading ≥ 140 or ≥ 90 Rescreen BP within a minimum of ≥ 1 day and ≤ 4 weeks
    and
    Recommend lifestyle modifications
    or
    Referral to alternative/primary care provider
    Second hypertensive BP reading ≥ 140 or ≥ 90 Recommend lifestyle modifications
    and
    1 or more of the second hypertensive reading interventions (see definitions)
    or
    Referral to alternative/primary care provider

    To Which Patients Does the Measure Apply?

    Denominator: All patients aged 18 years and older

    There are two criteria for inclusion of a patient into the denominator.

    1. Patient characteristics: Description located in “Denominator” (see above).
    2. Procedure codes (CPT and HCPCS): Codes located in “CPT Codes” and “HCPCS Codes.”

    The quality measure also has exclusions for the denominator.

    Diagnosis Codes

    This measure does not require a specific diagnosis to be submitted during the encounter.

    CPT Codes

    2018 additions in red.

    90791, 90792, 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99281, 99282, 99283, 99284, 99285, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, D7140, D7210, G0101, G0402, G0438, G0439

    2018 deletion of CPT codes 90832, 90834, 90837, 90839, 90845, 90880, 96118

    Without Telehealth Modifier: GQ, GT, 95, POS 2.

    Denominator note: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for registry-based measures.

    Exclusion (patient ineligible): G9744 Patient not eligible due to active diagnosis of hypertension. The patient has an active diagnosis of hypertension starts prior to the current encounter.

    How to Report the Measure

    Claims and IRIS Registry Manual Reporting

    2018 additions in red.

    Numerator: Patients who were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is pre-hypertensive or hypertensive

    Numerator note: Although the recommended screening interval for a normal BP reading is every 2 years, to meet the intent of this measure, BP screening and follow-up must be performed once per performance period. For patients with Normal blood pressure, a follow-up plan is not required. If the blood pressure is prehypertensive (SBP > 120 and <139 OR DBP >80 and <89) at a Primary Care Provider (PCP) encounter follow up as directed by the PCP would meet the intent of the measure (G8783).

    HCPCS Codes

    • Performance met (patient included in numerator and denominator): G8783 Normal blood pressure reading documented, follow-up not required
      G8950 Pre-Hypertensive or Hypertensive blood pressure reading documented, AND the indicated follow-up is documented
    • Denominator exclusion (patient not included in numerator or denominator): G9745 **Documented reason for not screening or recommending a follow-up for high blood pressure
    • Performance not met (patient not included in numerator, but included in denominator): G8785 Blood pressure reading not documented, reason not given
      G8952 Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given

    **Patients with a documented reason for not screening or follow-up plan for high blood pressure (denominator exception): This denominator exception should be evaluated during the most recent encounter in the performance period with a documented blood pressure.

    • Patient refuses to participate (either BP measurement or follow-up)
    • Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient’s health status. This may include but is not limited to severely elevated BP when immediate medical treatment is indicated

    How CMS Scores Your Performance

    • If you successfully report a measure for less than 60 percent of your patients, you will earn points based on your practice size:
      • Small practices (≤ 15 clinicians) will receive 3 points,
      • Larger practices (> 15 clinicians) will receive 1 point.
    • If you successfully report a measure for at least 60 percent of your patients, but do not report at least 20 cases, you will receive 3 points.
    • If you report this measure for at least 60 percent of applicable patients and on at least 20 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.
    Decile/PointsEHR (including IRIS integration)Registry (No EHR)Claims
    3 16.53 – 20.40 35.65 – 51.15 49.53 – 57.74
    4 20.41 – 23.94 51.16 – 64.21 57.75 – 66.45
    5 23.95 – 26.93 64.22 – 71.25 66.46 – 78.56
    6 26.94 – 29.99 71.26 – 76.46 78.57 – 90.52
    7 30.00 – 33.32 76.47 – 81.40 90.53 – 98.16
    8 33.33 – 37.61 81.41 – 88.06 98.17 – 99.99
    9 37.62 – 45.98 88.07 – 97.68 --
    10 >=45.99 >=97.69 100