2016 PQRS Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

DESCRIPTION

Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicated

INSTRUCTIONS

This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period. Eligible professionals who report 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 reported by eligible professionals who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. 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”.

DENOMINATOR

All patients aged 18 years and older

AND
Patient encounter during the reporting period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 90845, 90880, 92002, 92004, 92012, 92014, 96118, 97532, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99218, 99219, 99220, 99224, 99225, 99226, 99234, 99235, 99236, 99281, 99282, 99283, 99284, 99285, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99340, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, D7140, D7210, G0101, G0402, G0438, G0439

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 measurement period. The intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated. Normal blood pressure follow-up is not recommended for patients with clinical or symptomatic hypotension.

Definitions:
Blood Pressure (BP) Classification:
BP is defined by four (4) BP reading classifications: Normal, Pre-Hypertensive, First Hypertensive, and Second Hypertensive Readings.
Recommended BP Follow-Up:
The current Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC) 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 current JNC 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 current JNC 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 (ECG)

Recommended Blood Pressure Follow-up Interventions:
Normal BP: No follow-up required for Systolic BP  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 ClassificationSystolic BP mmHgDiastolic BP mmHgRecommended 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

Not Eligible – A patient is not eligible if one or more of the following reason(s) are documented:
 Patient has an active diagnosis of hypertension
 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

Numerator Quality-Data Coding Options for Reporting Satisfactorily:
Normal Blood Pressure Reading Documented, Follow-Up not Required
Performance Met: G8783: Normal blood pressure reading documented, follow-up not required
OR
Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, AND Indicated Follow-Up
Documented
Performance Met: G8950: Pre-Hypertensive or Hypertensive blood pressure reading documented, AND the indicated follow-up is documented

OR
Blood Pressure Reading not Documented, Patient not Eligible
Other Performance Exclusion: G8784: Blood pressure reading not documented, documentation the patient is not eligible
OR
Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up not Documented, Patient not Eligible
Other Performance Exclusion: G8951: Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible

OR
Blood Pressure Reading not Documented, Reason not Given
Performance Not Met: G8785: Blood pressure reading not documented, reason not given
OR
Pre-Hypertensive or Hypertensive Blood Pressure Reading Documented, Indicated Follow-Up not Documented, Reason not Given
Performance Not Met: G8952: Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given
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Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

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