CMS165v10 – Controlling High Blood Pressure

Patients 18-85 years of age 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.

– DENOMINATOR EXCLUSIONS

• Patients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period.
• Exclude patients who are in hospice care for any part of the measurement period.
• Exclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.
• Exclude patients 66 and older with an indication of frailty for any part of the measurement period who meet any of the following criteria:
  • Advanced illness with two outpatient encounters during the measurement period or the year prior
  • OR advanced illness with one inpatient encounter during the measurement period or the year prior
  • OR taking dementia medications during the measurement period or the year prior
• Exclude patients 81 and older with an indication of frailty for any part of the measurement period.
• Exclude patients receiving palliative care during the measurement period.

– 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:

Include patients 18-85 years of age who had a qualifying encounter/telephone visit/online assessment and diagnosis of essential hypertension starting before and continuing into, or starting during the first six months of the measurement period.

• To record an encounter, navigate to Patient > Provider Note > eSuperbill. Under the ‘Procedure- CPTs’ heading, enter the encounter code.

• To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses and click ‘Add’. Search for the diagnosis, add the diagnosis details, and click ‘Save’. Then click ‘Accept’ and the diagnosis is added to the provider note.

For Numerator:

Include patients fulfilling the following criteria:

• Patients with most recent diastolic blood pressure less than 90 during the measurement period. The blood pressure reading must not be recorded during an ‘ED’ or an ‘Encounter Inpatient’ encounter. To document the blood pressure reading, use the workflow Patient > Provider Note > Vitals. Click ‘Add’ and enter the reading under the ‘Blood Pressure’ heading. Then click ‘Accept’.

• Patients with most recent systolic blood pressure less than 140 during the measurement period. The blood pressure reading must not be recorded during an ‘ED’ or ‘Encounter Inpatient’ encounter. To document the blood pressure reading, use the workflow Patient > Provider Note > Vitals. Click ‘Add’ and enter the reading under the ‘Blood Pressure’ heading. Then click ‘Accept’.

For Denominator Exclusions:

Patients satisfying any of the following conditions are excluded from the denominator:

1. Patients who were in hospice care during the measurement year are included in denominator exclusion. To document that patient is receiving hospice care outside of a hospital or long term care facility, navigate to Patient > Clinical > Evaluations. Use the below mentioned codes to order or perform an intervention:
   • 385763009: Hospice Care (Regime/Therapy)
   • 385765002: Hospice Care Management (Procedure)

1. • To document an encounter inpatient, navigate to Patient > Clinical > Evaluations

2. Patients older than 65 years of age at the start of the measurement period and who spent longer than 90 consecutive days in a long term care during the measurement period. For documentation, navigate to Patient > Clinical > Evaluations

3. Patients 65 years of age or older with two or more outpatient encounters with advanced illness and fulfilling frailty criteria. Outpatient encounters should occur two years or less prior to the end of the measurement period. To document an outpatient encounter, navigate to Patient > Provider Note > eSuperbill. To document advanced illness diagnosis, use the workflow: Patient > Clinical > Diagnoses. Workflows for recording frailty criteria:
   • Frailty device ordered/applied during the measurement period: Patient > Clinical > Evaluations
   • Frailty diagnosis during the measurement period: Patient > Clinical > Diagnoses
   • Frailty symptoms during the measurement period: Patient > Clinical > Diagnoses or Patient > Clinical > Evaluations
   • Frailty encounter during the measurement period: Patient > Provider Note > eSuperbill

4. Patients 65 years of age or older having an inpatient encounter with advanced illness and fulfilling frailty criteria. Inpatient encounters should occur two years or less prior to the end of the measurement period. To document an inpatient encounter, navigate to Patient > Provider Note > eSuperbill. To document advanced illness diagnosis, use the workflow: Patient > Clinical > Diagnoses. Workflows for recording frailty criteria:
   • Frailty device ordered/applied during the measurement period: Patient > Clinical > Evaluations
   • Frailty diagnosis during the measurement period: Patient > Clinical > Diagnoses
   • Frailty symptoms during the measurement period: Patient > Clinical > Diagnoses or Patient > Clinical > Evaluations
   • Frailty encounter during the measurement period: Patient > Provider Note > eSuperbill

5. Patients 65 years of age or older taking dementia medication one year prior to or during the measurement period and fulfilling frailty criteria. Record the medication via the workflow Patient > Clinical > Prescription. Click ‘Add’ and search for the medication. Enter the medication details and click ‘Save’. Workflows for recording frailty criteria:
   • Frailty device ordered/applied during the measurement period: Patient > Clinical > Evaluations
   • Frailty diagnosis during the measurement period: Patient > Clinical > Diagnoses
   • Frailty symptoms during the measurement period: Patient > Clinical > Diagnoses or Patient > Clinical > Evaluations
   • Frailty encounter during the measurement period: Patient > Provider Note > eSuperbill

6. Patients with end stage renal disease procedures performed before the end of the measurement period. navigate to Patient > Provider Notes > Orders > Procedures.Click ‘Add’ and search for the procedure. Add the procedure details and click on ‘Save & Accept’/hover over ‘Sign & Accept’. If the user hover over ‘Sign & Accept’, then click ‘Complete’. The procedure is added to the provider note. 

Note:

Please ensure that the Procedure is present in the system. For this, navigate to Settings > Billing > Procedure. If the procedure is not added then, click on the ‘Add Procedure’ button.  

Here, enter the ‘Code’ and ‘Name’ of the Procedure. Once done, click on the ‘Save’ button.  

7. Patients with end stage renal disease encounter before the end of the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill.
8. Patients with pregnancy or renal diagnoses overlapping the measurement period. To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses.
9. Patients receiving palliative care during the measurement period.
   • To record the ‘Palliative Care Encounter’ performed, use the workflow Patient > Provider Note > eSuperbill.
   • To record the ‘Palliative Care Intervention’ performed, use the workflow Patient > Clinical > Evaluations.
   • To record the ‘Functional Assessment of Chronic Illness Therapy’ assessment performed, navigate to Patient > Clinical > Evaluations.