CMS165v11 – Controlling High Blood Pressure

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.

A qualifying visit in this case includes any of the following:

• Office Visit
• Annual Wellness Visit
• Preventive Care Services Established Office Visit, 18 and Up
• Preventive Care Services Initial Office Visit, 18 and Up
• Home Healthcare Services
• Online Assessments
• Telephone Visits

– 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 who are in hospice 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
  • Advanced illness with one inpatient encounter during the measurement period or the year prior
  • Taking dementia medications during the measurement period or the year prior.

  – 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.

  For Denominator:

  • To record an encounter/visit, navigate to Patient > Provider Notes > Create Superbill. Under the ‘Procedure- CPTs’ heading, enter the encounter code.
  
  • For documenting the diagnosis for hypertension, use the workflow Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant diagnosis. Fill out the details, and once done, click ‘Save’.
  

  For Numerator:
  

  To record a patient’s latest blood pressure, head over to Patient > Clinical > Vitals. Click ‘+ Add’ and locate the field titled ‘Blood Pressure’. Here, input the systolic and diastolic blood pressure values in their respective fields. Once done, click ‘Save’.

  

  For Denominator Exclusions:
  

  • To document ESRD, use the workflow Patient > Provider Notes > Diagnoses.
  
  • Documentation of renal transplant, dialysis and pregnancy can be done through Patient > Provider Notes > Orders > Procedures. Here, click ‘Add’ and search for the relevant procedure. Once done, click ‘Save & Accept’ or ‘Sign & Accept’.
  
  • To document a patient receiving hospice care, navigate to Patient > Provider Notes > Evaluations. Hospice Care can also be recorded by the workflow Patient > Provider Notes > Create Superbill. Under the ‘Procedure-CPTs’ heading, add the relevant hospice care code.
  
  • To record an encounter for patients living long term in nursing homes, head over to Patient > Provider Notes > Create Superbill or to Patient > Provider Notes > Evaluations. Here, click ‘Add’ and search for the relevant finding.
  
  • To document an outpatient encounter for advanced illness, navigate to Patient > Provider Notes > Create Superbill. The outpatient encounters can include any of the following:
    • Outpatient
    • Observation
    • Emergency Department Visit
    • Nonacute Inpatient
  • To document an advanced illness, use the workflow: Patient > Provider Notes > Diagnoses. Click ‘Add’ and search for the relevant advanced illness.

  Note: The advanced illness is to be diagnosed during the outpatient encounter.

  

  • To record frailty criteria, the following workflows can be used:
    • Frailty device ordered/ applied during the measurement period: Patient > Provider Notes > Procedures or through Patient > Provider Notes > Evaluations
  
  • • Frailty diagnosis during the measurement period: Patient > Provider Notes > Diagnoses
  
  • • Frailty symptoms during the measurement period: Patient > Provider Notes > Diagnoses or Patient > Provider Notes > Evaluations.
    • Frailty encounter during the measurement period: Patient > Provider Notes > Create Superbill.
  
  • To document an inpatient encounter for advanced illness, navigate to Patient > Provider Notes > Create Superbill or document via Patient > Provider Notes > Evaluations.
  • The dementia medication can be documented using the workflow Patient > Provider Notes > Medications.
  
  • To record a palliative assessment, head over to Patient > Provider Notes > Evaluations or to Patient > Provider Notes > Assessments.
  
  • To record a palliative encounter, navigate to Patient > Provider Notes > Create Superbill or to Patient > Provider Notes > Diagnoses. Here, document a diagnosis for ‘Encounter for palliative care’.
  
  • To record a palliative intervention, navigate to Patient > Provider Notes > Evaluations.