236. Controlling High Blood Pressure

Screen the patient for high blood pressure:

1. Create a visit note.
2. On the Overview screen, tap Vitals.

   You may need to swipe left on the second row of tiles to see Vitals.

3. Record the Systolic, Diastolic, and Position.

   A systolic less than 140 and diastolic less than 90 qualify this exam for this measure.

4. Open the Ocular Exam.
5. Select Essential Hypertension from Impressions.
6. Select any Plan.
7. Tap Special Plans and select MIPS.
8. From Popular Plans, select MIPS Quality.
9. Tap the More tab and select BP.
10. Select an outcome from the Quality 236 drop-down.
11. Tap Done.
12. Document the rest of the exam and Finalize.

Alternatively, code quality with a special plan:

1. Open the Ocular Exam.
2. Select a Diagnosis and Plan.
3. Tap Special Plans and select MIPS.
4. From Popular Plans, select MIPS Quality.
5. Tap the More tab.
6. Select BP.
7. Select the appropriate procedure from the Quality 236 drop-down.
8. Tap Done.
9. Document the rest of the exam and Finalize.

Screen the patient for high blood pressure:

1. In a patient’s exam record in ExamWRITER, record the office visit (992xx).
2. Click the Exam - Special Tests tab.
3. Click the yellow Vital Signs button.
4. Click your cursor in the Blood Pressure box, record the patient’s Systolic, Diastolic, and Pulse in the Blood Pressure/Pulse window select any applicable check boxes, and click Save/Exit.
5. Record a diagnosis that indicates essential hypertension (I10).
6. Click the Examination bar, select the Systemic check box, click Process, select Hypertension, and click Process.

   OR select Hypertensive in any of the retinal tests performed in Special Testing.

7. Document the rest of the exam.
8. Click the Coding taskbar icon.
9. On the diagnosis tab, click Clear All and click Auto Code.

Eyefinity products and documentation refer to the MIPS quality numbers. Other measure numbering systems are listed here for your reference.

Quality	236
NQF	0018
CMS	165

• Claims (ExamWRITER only)
• EHR (ExamWRITER only)
• Registry (Eyefinity EHR only)
• AAO IRIS

This topic describes how points are calculated for this measure. To learn more about scoring, go to Scoring.

Benchmarks are displayed here as both a chart and a table. The chart gives you a visual representation and helps you quickly compare benchmarks across different reporting methods. The table lists the specific benchmark criteria for each available reporting method.

 

Submission Method	3rd Decile	4th Decile	5th Decile	6th Decile	7th Decile	8th Decile	9th Decile	10th Decile
Claims (ExamWRITER only)	20– 29.99	30– 39.99	40– 49.99	50– 59.99	60– 69.99	70– 79.99	80– 89.99	≥ 90
EHR (ExamWRITER only)	51.69– 57.07	57.08– 61.32	61.33– 64.79	64.8– 68.44	68.45– 72.03	72.04– 76.35	76.36– 82.37	≥ 82.38
Registry (Eyefinity EHR only)	20– 29.99	30– 39.99	40– 49.99	50– 59.99	60– 69.99	70– 79.99	80– 89.99	≥ 90
AAO IRIS	20– 29.99	30– 39.99	40– 49.99	50– 59.99	60– 69.99	70– 79.99	80– 89.99	≥ 90

Patients aged 18 to 85 years;

AND who had a diagnosis of essential hypertension:

AND who had a visit during the measurement period or the year prior to the measurement period:

Denominator Exclusions

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

OR documentation of end-stage renal disease (ESRD), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period:

OR patients age 66 or older in Institutional Special Needs Plans (SNP) or residing in long-term care with POS code 32, 33, 34, 54, or 56 for more than 90 days during the measurement period:

OR patients 66–80 years of age with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia during the measurement period or the year prior to the measurement period:

OR patients 66–80 years of age with at least one claim/encounter for frailty during the measurement period AND either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ED or nonacute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period:

OR patients 81 years of age and older with at least one claim/encounter for frailty during the measurement period:

Patients whose most recent blood pressure is adequately controlled during the measurement period.

Performance Met

Most recent systolic blood pressure less than 140 mmHg:

AND most recent diastolic blood pressure less than 90 mmHg:

Performance Not Met

Most recent systolic blood pressure greater than or equal to 140 mmHg:

OR most recent diastolic blood pressure greater than or equal to 90 mmHg:

OR

No documentation of blood pressure measurement, reason not given:

To visualize these possible scenarios, refer to the following table.

	Systolic
Diastolic		< 140	≥ 140
	< 90	G5752 G8754 Performance met	G8753 G8754 Performance not met
	≥ 90	G8752 G8755 Performance not met	G8753 G8755 Performance not met

 

Measures 236 and 317 are closely related. Refer to the table below to understand how exam procedures and findings impact each measure.

Criteria	Measure		Notes
	317: Preventive Care & Screening	236: Controlling High BP
Age	18 and over	18–85
Procedure code(s)	992xx or 92xxx	992xx
Diagnosis	I10	I10	If the I10 diagnosis was completed before the exam date, the patient is excluded from the results for Measure 317
The conditions above this line affect which options are available below
Active diagnosis of hypertension	G9744 (exclusion)	—	This selection allows BP to be recorded, but restricts other BP check box selections
Patient refused	G9745 (exception)	—	No further coding can be done for 317
Urgent or emergent situation	G9745 (exception)	—	No further coding can be done for 317
BP <120 and <80	G8783	—
BP ≥120 and ≥80 AND referred to alt. provider	G8950	—
BP ≥120 and ≥80 NOT referred to alt. provider	G8952 (not met)	—
Systolic <140	—	G8752	Both systolic and diastolic measures required; any not met results in not met
Systolic ≥140	—	G8753 (not met)
Diastolic <90	—	G8754
Diastolic ≥90	—	G8755 (not met)
BP is blank	G8785 (not met)	G8756 (not met)	These codes are overwritten if any of the above are selected