CMS165v12 – Controlling High Blood Pressure

Patients 18-85 years of age by the end of the measurement period who had a visit during the measurement period 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

– 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.

Note: This blood pressure reading should not have been taken during an emergency department visit or an inpatient encounter.

– DENOMINATOR EXCLUSIONS

• Patients with evidence of:
  • End stage renal disease (ESRD Diagnosis or Encounter)
  • Dialysis
  • Renal transplant/ESRD Procedure/Kidney 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
  • 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
• Patients 81 and older by the end of the measurement period with an indication of frailty for any part of the measurement period.
• Patients receiving palliative care for any part of the measurement period.

For Denominator:

• To record a visit, navigate to Patient > Provider Note > 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 > Provider Note > Vitals. Click ‘Add’ and enter the systolic and diastolic blood pressure readings in the respective fields. Once done, click ‘Accept’.

For Denominator Exclusions:

• To document
  • ESRD
  • Pregnancy

use the workflow Patient > Provider Note > Diagnoses.

• An ESRD encounter can be recorded via Patient > Provider Note > Create Superbill.

• Documentation of
  • Renal transplant/Kidney Transplant
  • Dialysis

can be done through Patient > Provider Note > Order > Procedures. Here, click ‘Add’ and search for the relevant procedure. Once done, click ‘Save & Accept’ or ‘Sign & Accept’.

• To document that a patient is receiving hospice care outside of a hospital or long-term care facility, navigate to Patient > Provider Note > Evaluations. Use the below mentioned codes to order or perform an intervention:
  • 385763009: Hospice Care (Regime/Therapy)
  • 385765002: Hospice Care Management (Procedure)

• To document an inpatient encounter, navigate to Patient > Provider Note > Evaluations.

• To document a hospice care assessment, follow the workflow Patient > Provider Note > Evaluations. Click ‘Add’ and search for ‘Hospice Care [Minimum Data Set]’. Then select ‘Performed’ from the ‘Status’ dropdown and ‘Yes’ from the ‘Result’ field.

• A hospice encounter can be documented through Patient > Provider Note > Evaluations or Patient > Provider Note > Create Superbill.
• To record an encounter for patients living long term in nursing homes, head over to Patient > Provider Note > Create Superbill or to Patient > Provider Note > Evaluations. Here, click ‘Add’ and search for the relevant finding.

• To document an outpatient encounter for advanced illness, navigate to Patient > Provider Note > 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 Note > Diagnoses. Click ‘Add’ and search for the relevant advanced illness.

• To document an inpatient encounter for advanced illness, navigate to Patient > Provider Notes > Create Superbill or document via Patient > Provider Note > Evaluations.

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 Note > Evaluations. From the ‘Status’ dropdown select ‘Ordered’ or ‘Applied’.

• Frailty diagnosis during the measurement period: Patient > Provider Note > Diagnoses

• Frailty symptoms during the measurement period: Patient > Provider Note > Diagnoses or Patient > Provider Note > Evaluations.

• • Frailty encounter during the measurement period: Patient > Provider Note > Create Superbill

• The dementia medication can be documented using the workflow Patient > Provider Notes > Medications OR Patient > Provider Note > Prescription.

• To record a palliative assessment/intervention, head over to Patient > Provider Note > Evaluations.

• To record a palliative encounter, navigate to Patient > Provider Note > Create Superbill or to Patient > Provider Note > Diagnoses. Here, a diagnosis for ‘Encounter for palliative care’.