2021 MIPS Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

Measure Type High Priority Measure? Collection Type(s)
Process no Medicare Part B Claims, eCQM, MIPS CQM

Measure Description

Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is pre-hypertensive or hypertensive

Instructions

This measure is to be submitted at each visit for patients seen during the measurement period. Merit-based Incentive Payment System (MIPS) eligible clinicians who submit the measure must perform the blood pressure screening at each patient visit by a MIPS eligible clinician and may not obtain measurements from external sources.

This measure may be submitted by MIPS eligible clinicians who perform the quality actions described in the measure based on the services provided and the measure-specific denominator coding. The intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated. Both the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures on the same date of service, use the most recent (last reading documented) as the representative blood pressure. The documented follow-up plan must be related to the current BP reading as indicated, example: “Patient referred to primary care provider for BP management”.

Measure Submission Type

Measure data may be submitted by individual MIPS eligible clinicians, groups, or third-party intermediaries. The listed denominator criteria are used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions as allowed by the measure. The quality-data codes listed do not need to be submitted by MIPS eligible clinicians, groups, or third-party intermediaries that utilize this modality for submissions; however, these codes may be submitted for those third-party intermediaries that utilize Medicare Part B claims data. For more information regarding Application Programming Interface (API), please refer to the Quality Payment Program (QPP) website.

Denominator

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

Definition:Not Eligible for High Blood Pressure Screening (Denominator Exclusion) -• Patient has an active diagnosis of hypertension starts prior to the current encounterDENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for MIPS CQMs.

Denominator Criteria (Eligible Cases):Patients aged ≥ 18 years

AND

Patient encounter during the performance period (CPT or HCPCS): 90791, 90792, 92002, 92004, 92012, 92014, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99281, 99282, 99283, 99284, 99285, 99215, 99236, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7251, G0101, G0402, G0438, G0439

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

AND NOT

DENOMINATOR EXCLUSION:

Patient not eligible due to active diagnosis of hypertension: G9744

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

NUMERATOR NOTE: Although the recommended screening interval for a normal BP reading is every 2 years, to meet the intent of this measure, BP screening and follow-up must be performed once per performance period. For patients with Normal blood pressure, a follow-up plan is not required (G8783). If the blood pressure is pre-hypertensive (SBP > 120 and <139 OR DBP >80 and <89) at a Primary Care Provider (PCP) encounter follow up as directed by the PCP would meet the intent of the measure (G8950).

Definitions:

Blood Pressure (BP) Classification – BP is defined by four (4) BP reading classifications: Normal, Pre- Hypertensive, First Hypertensive, and Second Hypertensive Readings

Recommended BP Follow-Up – The Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends BP screening intervals, lifestyle modifications and interventions based on the current BP reading as listed in the “Recommended Blood Pressure Follow- Up Interventions” listed below

Recommended Lifestyle Modifications – The JNC 7 report outlines lifestyle modifications which must include one or more of the following as indicated:

  • Weight Reduction
  • Dietary Approaches to Stop Hypertension (DASH) Eating Plan
  • Dietary Sodium Restriction
  • Increased Physical Activity
  • Moderation in alcohol (ETOH) Consumption

Second Hypertensive Reading – Requires a BP reading of systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg during the current encounter AND a most recent BP reading within the last 12 months systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg

Second Hypertensive BP Reading Interventions – The JNC 7 report outlines BP follow-up interventions for a second hypertensive BP reading and must include one or more of the following as indicated:

  • Anti-Hypertensive Pharmacologic Therapy
  • Laboratory Tests
  • Electrocardiogram (ECG)

Recommended Blood Pressure Follow-up Interventions –

  • Normal BP: No follow-up required for Systolic BP <120 mmHg AND Diastolic BP < 80 mmHg
  • Pre-Hypertensive BP: Follow-up with rescreen every year with systolic BP of 120-139 mmHg OR diastolic BP of 80-89 mmHg AND recommended lifestyle modifications OR referral to Alternate/Primary Care Provider
  • First Hypertensive BP Reading: Patients with one elevated reading of systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg:
    • Follow-up with rescreen > 1 day and < 4 weeks AND recommend lifestyle modifications OR referral to Alternative/Primary Care Provider
  • Second Hypertensive BP Reading: Patients with second elevated reading of systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg:
    • Follow-up with Recommended lifestyle recommendations AND one or more of the Second Hypertensive Reading Interventions OR referral to Alternative/Primary Care Provider

Recommended Blood Pressure Follow-Up Table

BP Classification Systolic BP mmHg Diastolic BP mmHg Recommended Follow-Up

(must include all indicated actions for each BP Classification)

Normal

BP Reading

< 120 AND < 80 No Follow-Up required
Pre-Hypertensive BP Reading ≥ 120 AND ≤ 139 OR

≥ 80 AND ≤ 89

Rescreen BP every year AND

Recommend Lifestyle Modifications

OR

Referral to Alternative/Primary Care Provider

First Hypertensive BP Reading ≥ 140 OR ≥ 90 Rescreen BP > 1 day and < 4 weeks AND recommended lifestyle modifications

OR

Referral to Alternative/Primary Care Provider

Second

Hypertensive BP

Reading

≥ 140 OR ≥ 90 Recommended lifestyle recommendations AND

one or more of the Second Hypertensive Reading Interventions (anti-hypertensive pharmacologic therapy, laboratory tests, electrocardiogram [ECG])OR

Referral to Alternative/Primary Care Provider

Patients with a Documented Reason for not Screening or Follow-Up Plan for High Blood Pressure (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 NOTE: Although the recommended screening interval for a normal BP reading is every 2 years, to meet the intent of this measure, BP screening and follow-up must be performed at every patient visit. For patients with Normal blood pressure, a follow-up plan is not required (G8783). Denominator Exception(s) are determined on the date of the denominator eligible encounter.

Numerator Options:

Performance Met:

Normal blood pressure reading documented, follow-up not required (G8783)

OR

Performance Met:

Pre-Hypertensive or Hypertensive blood pressure reading documented, AND the indicated follow-up is documented (G8950)

OR

Denominator Exception:

Documented reason for not screening or recommending a follow-up for high blood pressure (G9745).

OR

Performance Not Met:

Blood pressure reading not documented, reason not given (G8785)

OR

Performance Not Met:

Pre-Hypertensive or Hypertensive blood pressure reading documented, indicated follow-up not documented, reason not given (G8952)