236. Controlling High Blood Pressure

Percentage of patients 18–85 years of age who had a diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period, and whose most recent blood pressure was adequately controlled (<140/90mmHg) during the measurement period.

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.

  • In reference to the numerator element, only blood pressure readings performed by a clinician or a remote monitoring device are acceptable for numerator compliance with this measure. This includes blood pressures taken in person by a clinician and blood pressures measured remotely by electronic monitoring devices capable of transmitting the blood pressure data to the clinician. Blood pressure readings taken by a remote monitoring device and conveyed by the patient to the clinician are also acceptable. It is the clinician’s responsibility and discretion to confirm the remote monitoring device used to obtain the blood pressure is considered acceptable and reliable and whether the blood pressure reading is considered accurate before documenting it in the patient’s medical record.
  • 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. Ranges and thresholds do not meet criteria for this measure. A distinct numeric result for both the systolic and diastolic BP reading is required for numerator compliance.

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

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) 20.00– 29.99 30.00– 39.99 40.00– 49.99 50.00– 59.99 60.00– 69.99 70.00– 79.99 80.00– 89.99 ≥ 90.00
EHR (ExamWRITER only) — — — — — — — —
Registry (Eyefinity EHR only) 20.00– 29.99 30.00– 39.99 40.00– 49.99 50.00– 59.99 60.00– 69.99 70.00– 79.99 80.00– 89.99 ≥ 90.00
AAO IRIS (Eyefinity EHR only) 20.00– 29.99 30.00– 39.99 40.00– 49.99 50.00– 59.99 60.00– 69.99 70.00– 79.99 80.00– 89.99 ≥ 90.00

Patients aged 18 to 85 years on the date of the encounter;

AND who had a diagnosis of essential hypertension:

I10

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

98980, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, 99421, 99422, 99423, 99457, G0438, G0439, G2250, G2251, G2252

The diagnosis of essential hypertension must be present some time between one year prior to the measurement period and the first six months of the measurement period (i.e., between January 1 of the prior year and June 30 of the current year).

92000 series codes are not included in this measure.

CPT codes listed with an asterisk (*) are noncovered services under the Physician Fee Schedule and will not be counted toward the denominator in claims-based reporting.

Denominator Exclusions

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

G9740

OR

Palliative care services given to patient any time during the measurement period:

G0031

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 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 consecutive days during the measurement period:

G9910

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:

G2115

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:

G2116

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

G2118

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

  • Reporting requires codes for both systolic and diastolic blood pressure regardless of performance met/not met status.
  • The G-codes will autocode only when the denominator requirements are satisfied. They will not autocode for 92000 series exams.

Performance Met

Most recent systolic blood pressure less than 140 mmHg:

G8752

AND most recent diastolic blood pressure less than 90 mmHg:

G8754

Performance Not Met

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

G8753 (with G8754 or G8755)

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

G8755 (with G8752 or G8753)

OR

No documentation of blood pressure measurement, reason not given:

G8756

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