CMS22v11 – Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

– DENOMINATOR EXCLUSION

Patient has an active diagnosis of hypertension

-DENOMINATOR EXCEPTION

• Documentation of medical reason(s) for not screening for high blood pressure (e.g., patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status).
• Documentation of patient reason(s) for not screening for blood pressure measurements or for not ordering an appropriate follow-up intervention if patient BP is elevated or hypertensive (e.g., patient refuses).

– NUMERATOR

Patient visits where patients were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is elevated or hypertensive.

For Denominator:

Include patients aged 18 years and older at the start of the measurement period with a qualifying encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill. Under the ‘Procedure – CPTs’ heading, enter the encounter code.

For Numerator:

Include patients satisfying any of the following conditions:

• Patients having normal blood pressure reading during a qualifying encounter during the measurement period. The systolic blood pressure result should be in range 1-120 mm[Hg] and diastolic blood pressure result should be in range 1-80 mm[Hg]. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals. Then, click on the ‘Add’ button. Enter the blood pressure reading under the ‘Blood Pressure’ heading and click ‘Accept’.

• Patients with a qualifying encounter during the measurement period and elevated blood pressure reading. The systolic BP reading should be in the interval, 120 mm[Hg] to 129 mm[Hg] and the diastolic BP reading should be less than 80 mm[Hg]. In addition, the patient should either have non-pharmacological intervention or ‘follow-up with rescreen in 2 to 6 months’ ordered on the day of encounter. To record the qualifying encounter, navigate to Patient > Provider Note > eSuperbill. To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.
  • To document the non-pharmacological intervention or follow-up with rescreen in 2 to 6 months, use the workflow Patient > Clinical > Evaluations. Click ‘+ Add’ and search for the intervention. Select ‘Ordered’ from the ‘Status’ dropdown and click ‘Sign’ or ‘Save.

• Patients with a qualifying encounter during the measurement period and elevated blood pressure reading and a referral. The systolic BP reading should be in the interval, 120 mm[Hg] to 129 mm[Hg] and the diastolic BP reading should be less than 80 mm[Hg]. Moreover, the referral to alternate or primary healthcare professional for hypertensive reading should be ordered on the day of encounter.
  • To record the qualifying encounter, navigate to Patient > Provider Note > eSuperbill.
  • To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.
  • To document the referral, use the workflow Patient > Clinical > Evaluations. Click ‘+ Add’ and search for the intervention. Select ‘Ordered’ from the ‘Status’ dropdown and a reason from the ‘Reason’ dropdown. Then click ‘Sign’ or ‘Save.
• Patients having an encounter with second hypertensive reading and a referral to alternate or primary healthcare professional for hypertensive reading. The referral should be ordered on the day of encounter. The systolic BP result should be in the interval, 130 mm[Hg] to 139 mm[Hg] and the diastolic BP result should be in the interval, 80 mm[Hg] to 89 mm[Hg].
  • To document the referral, use the workflow Patient > Clinical > Evaluations. Click ‘+ Add’ and search for the intervention. Select ‘Ordered’ from the ‘Status’ dropdown and a reason from the ‘Reason’ dropdown. Then click ‘Sign’ or ‘Save.
  • To record the qualifying encounter, navigate to Patient > Provider Note > eSuperbill.
  • To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.
  • In addition, the patient should have an encounter with hypertensive reading within year prior. Navigate to Patient > Provider Note > eSuperbill and Patient > Provider Note > Clinical > Vitals for recording the qualifying encounter and the blood pressure reading respectively. The systolic BP result should be in the range, 0 to 130 mm[Hg] and the diastolic BP result should be in the interval 0 to 80 mm[Hg].

• Patients having an encounter with second hypertensive reading and encounter interventions. The systolic BP result should be in the interval, 130 mm[Hg] to 139 mm[Hg] and the diastolic BP result should be in the interval, 80 mm[Hg] to 89 mm[Hg]. In addition, the patient should have an encounter with hypertensive reading within year prior.
  • To record the qualifying encounter, navigate to Patient > Provider Note > eSuperbill.
  • To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.
  • For the encounter interventions, the patient should have a follow-up with rescreen in 2 to 6 months and non-pharmacological interventions ordered on the same day as the laboratory test or ECG for hypertension. To document the non-pharmacological intervention or follow-up with rescreen in 2 to 6 months, use the workflow Patient > Clinical > Evaluations.
  • To record a lab test, navigate to Patient > Clinical > Orders&Results > Labs and click ‘+ Add Order’ button.

Here, select a laboratory and search for the lab test. Once done, click on the ‘Save’ or ‘Sign’ button.

Next, click on the ‘Mark As Received’ button.

On the ‘Edit Lab Result’ screen, add the observations and click on the ‘Save’ button.

To document an ECG diagnostic study, use the workflow Patient > Clinical > Orders & Results > Radiology. Click ‘+ Order’ and add the radiology order details. Then hover over ‘Sign’ and click ‘Queue’.

Mark the radiology order as completed by clicking the ‘Mark As Completed’ button.

Note:

For LOINC Codes Based Labs: Please ensure that the test code is mapped to a LOINC Code from the Settings. To map a LOINC with the radiology test code, navigate to Settings > EHR > Radiology. Select the radiology test and navigate to the ‘Code’ tab. Then, click on a code. Under the ‘Result Codes and LOINCS’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’. 

For CPT Codes Based Labs: When a CPT code is added to a test order, please ensure that the CPT code is present in the ‘Procedures’. 

Moreover, the CPT code should be mapped to a LOINC Code from the Settings. To map a LOINC with the CPT code, navigate to Settings > Billing > Procedure. Select the CPT code and navigate to the ‘Edit Procedure’ tab. Under the ‘Procedure Components’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’. 

• Patients having first hypertensive reading with first hypertension reading interventions or referral to alternate professional. The interventions or referral should be ordered on the day of encounter.
  • To record the qualifying encounter, navigate to Patient > Provider Note > eSuperbill.
  • To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals. The systolic BP result should be greater than 130 mm[Hg] and the diastolic BP result should be greater than 80 mm[Hg].
  • The patient should not have an encounter with hypertensive reading within year prior.
  • To document follow-up within 4 weeks and non-pharmacological interventions on the same day, use the workflow Patient > Clinical > Evaluations.
  • To document the referral, use the workflow Patient > Clinical > Evaluations.
• Patients having an encounter with second hypertensive reading and second hypertensive reading interventions or referral to alternate or primary healthcare professional for hypertensive reading. The systolic BP result should be greater than 140 mm[Hg]and the diastolic BP result should be greater than 90 mm[Hg]. In addition, the patient should have an encounter with hypertensive reading within year prior.
  • To record the qualifying encounter, navigate to Patient > Provider Note > eSuperbill.
  • To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.
  • To document the referral, use the workflow Patient > Clinical > Evaluations.
  • For the second hypertensive reading interventions, the patient should have a follow-up within 4 weeks and non-pharmacological interventions ordered on the same day as the laboratory test or ECG for hypertension. To document the non-pharmacological intervention or follow-up within 4 weeks, use the workflow Patient > Clinical > Evaluations. Furthermore, there should be a record of ‘pharmacologic therapy for hypertension’ medication ordered on the date of order of interventions. Navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Save’.

• • To record a lab test or ECG diagnostic study, navigate to Patient > Clinical > Orders&Results > Labs or Patient > Clinical > Orders & Results > Radiology respectively.

– For Denominator Exceptions:

The denominator exceptions for this measure include:

• Patients having a medical or patient reason documented for not performing blood pressure measurement during a qualifying encounter during the measurement period. To record a reason, use the workflow Patient > Provider Note > Clinical > Vitals. Click ‘Add’ and then click ‘Accept’ without entering the readings for blood pressure. Select a reason from the ‘Blood Pressure’ dropdown in the ‘Vitals not Recorded’ pop-up. Then click ‘Save’.

Note: Please ensure that the ‘Blood Pressure’ checkbox is marked in the ‘Patient’ preferences. To mark the checkbox, navigate to Personal > My Preferences > Patient. Once done, click ‘Save’.

• Patients having an encounter with second hypertensive reading (systolic BP: greater than or equal to 140 and diastolic BP: greater than or equal to 90) and one of the following not ordered:
  • Laboratory test or ECG for hypertension
  • Pharmacologic therapy for hypertension
  • To record the below mentioned interventions as not ordered navigate to Patient > Clinical > Evaluations. Click ‘+ Add’ and search for the intervention. Select ‘Not Ordered’ from the ‘Status’ dropdown and a reason from the ‘Reason’ dropdown. Then click ‘Sign’ or ‘Save. The follow-up should be recorded as declined on the day of the encounter.
    • Referral to primary care or alternate provider
    • Follow-up within 4 weeks
    • Non-pharmacological interventions

• Patients having an encounter with second hypertensive reading (systolic BP: 130 to 139 and diastolic BP: 80 to 89) and one of the following not ordered:
  • Laboratory test or ECG for hypertension
  • To record the below mentioned interventions as not ordered navigate to Patient > Clinical > Evaluations. Click ‘+ Add’ and search for the intervention. Select ‘Not Ordered’ from the ‘Status’ dropdown and a reason from the ‘Reason’ dropdown. Then click ‘Sign’ or ‘Save. The follow-up should be recorded as declined on the day of the encounter.
    • Referral to primary care or alternate provider
    • Follow-up 2-3 months (finding)
    • Follow-up 4-6 months (finding)
    • Non-pharmacological interventions

• Patients having an encounter with first hypertensive reading (systolic BP: 120 to 129 and diastolic BP: less than 80) and one of the following not ordered:
  • Referral to primary care or alternate provider
  • Follow-up 2-3 months (finding)
  • Follow-up 4-6 months (finding)

Navigate to Patient > Clinical > Evaluations. Click ‘+ Add’ and search for the intervention. Select ‘Not Ordered’ from the ‘Status’ dropdown and a reason from the ‘Reason’ dropdown. Then click ‘Sign’ or ‘Save. The follow-up should be recorded as declined on the day of the encounter.

• Patients having an encounter with elevated blood pressure reading (systolic BP: greater than or equal to 130 and diastolic BP: greater than or equal to 80) and one of the following not ordered:
  • Referral to primary care or alternate provider
  • Follow-up within 4 weeks
  • Non-pharmacological interventions

Navigate to Patient > Clinical > Evaluations. Click ‘+ Add’ and search for the intervention. Select ‘Not Ordered’ from the ‘Status’ dropdown and a reason from the ‘Reason’ dropdown. Then click ‘Sign’ or ‘Save. The follow-up should be recorded as declined on the day of the encounter.

– For Denominator Exclusions:

Exclude patients with a diagnosis for hypertension with a qualifying encounter during the measurement period such that the diagnosis overlaps before the encounter. To record the hypertension diagnosis, use the workflow Patient > Provider Note > Diagnosis. Click ‘Add’ and search for the diagnosis. Add the diagnosis details and click ‘Save’. Then click ‘Accept’ and the diagnosis is added to the provider note.