CMS22v9 – Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

All patient visits for patients aged 18 years and older at the beginning of the measurement period.

– 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 is pre-hypertensive 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 pre-hypertensive 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 having pre-hypertensive blood pressure reading during a qualifying encounter during the measurement period. The systolic blood pressure result should be in range 1-140 mm[Hg] and diastolic blood pressure result should be in range 1-90 mm[Hg]. In addition, either the systolic blood pressure result should be greater than or equal to 120 or diastolic blood pressure reading should be greater than or equal to 80. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.

The patient should also have an order for high blood pressure intervention on the same day as start of the qualifying encounter. To record the intervention, use the workflow Patient > Clinical > Evaluations. Click ‘+ Add’ and search for the intervention. Select ‘Ordered’ from the ‘Status’ dropdown and click ‘Sign’ or ‘Save.

Furthermore, the patient should also have an order for follow up within one-year intervention on the same day as start of the qualifying encounter. To record the intervention, 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 having pre-hypertensive blood pressure reading during a qualifying encounter during the measurement period. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.

The patient should also have an order for the intervention, referral to alternate provider for high blood pressure reading.  The referral should be ordered on the same day as start of the qualifying encounter. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To record the intervention, 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 first high blood pressure reading during a qualifying encounter during the measurement period. Either, the systolic blood pressure result should be greater than or equal to 140 or the diastolic blood pressure reading should be greater than or equal to 90. In addition, the patient should not have an encounter with high blood pressure reading 1 year or less before start of the qualifying encounter. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.

The patient should also have an order for high blood pressure intervention on the same day as start of the qualifying encounter. To record the intervention, use the workflow Patient > Clinical > Evaluations. Click ‘+ Add’ and search for the intervention. Select ‘Ordered’ from the ‘Status’ dropdown and click ‘Sign’ or ‘Save.

Furthermore, the patient should also have an order for follow up within 4 weeks, intervention on the same day as start of the qualifying encounter. To record the intervention, 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 having first high blood pressure reading during a qualifying encounter during the measurement period. Either, the systolic blood pressure result should be greater than or equal to 140 or the diastolic blood pressure reading should be greater than or equal to 90. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.

The patient should also have an order for the intervention, referral to alternate provider for high blood pressure reading. The referral should be ordered on the same day as start of the qualifying encounter. To record the intervention, 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 high blood pressure reading during a qualifying encounter during the measurement period along with an encounter with high blood pressure reading 1 year or less before start of qualifying encounter. Either, the systolic blood pressure result should be greater than or equal to 140 or the diastolic blood pressure reading should be greater than or equal to 90. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.

The patient should also have an order for high blood pressure intervention on the same day as start of the qualifying encounter. To record the intervention, use the workflow Patient > Clinical > Evaluations.

Furthermore, the patient should have ‘Laboratory test for hypertension’ ordered on the same day as start of the qualifying encounter. 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.

Note:

Please ensure that the lab code is mapped to a LOINC Code from the Settings. To map a LOINC with the lab code, navigate to Settings > EHR > Laboratory. Select the Lab and navigate to the ‘Code’ tab. Then, click on the Lab Order. Under the ‘Result Codes and LOINCS’ heading, add a Code, LOINC and Description and click on the ‘Add’ button.

Once done, click on ‘Save’. 

When a CPT code is added to a lab 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 high blood pressure reading during a qualifying encounter during the measurement period along with an encounter with high blood pressure reading 1 year or less before start of qualifying encounter. Either, the systolic blood pressure result should be greater than or equal to 140 or the diastolic blood pressure reading should be greater than or equal to 90. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.

The patient should also have an order for high blood pressure intervention on the same day as start of the qualifying encounter. To record the intervention, use the workflow Patient > Clinical > Evaluations.

Furthermore, the patient should have ‘EKG 12 channel panel’ or ‘EKG study’ diagnostic study ordered on the same day as start of the qualifying encounter. To document the 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 high blood pressure reading during a qualifying encounter during the measurement period along with an encounter with high blood pressure reading 1 year or less before start of qualifying encounter. Either, the systolic blood pressure result should be greater than or equal to 140 or the diastolic blood pressure reading should be greater than or equal to 90. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.

The patient should also have an order for high blood pressure intervention on the same day as start of the qualifying encounter. To record the intervention, use the workflow Patient > Clinical > Evaluations.

Furthermore, the patient should have ‘Pharmacologic therapy for hypertension’ medication ordered on the same day as start of the qualifying encounter. navigate to Patient > Provider Note > Prescription. Click ‘Add’ and search for the prescription. Enter the prescription details and click ‘Save’.

• Patients having high blood pressure reading during a qualifying encounter during the measurement period along with an encounter with high blood pressure reading 1 year or less before start of qualifying encounter. Either, the systolic blood pressure result should be greater than or equal to 140 or the diastolic blood pressure reading should be greater than or equal to 90. To record an encounter, navigate to Patient > Provider Note > eSuperbill. To record the blood pressure reading, navigate to Patient > Provider Note > Clinical > Vitals.

The patient should also have an order for the intervention, referral to alternate provider for high blood pressure reading. The referral should be ordered on the same day as start of the qualifying encounter. To record the intervention, use the workflow Patient > Clinical > Evaluations.

– 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’.

– 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.