Feb 1, 2023 • Administrative

The Controlling High Blood Pressure (CBP) HEDIS® measure can be challenging as it not only requires proof of a blood pressure (BP) reading, but also that the patient’s blood pressure is adequately controlled. CBP care gaps can open and close throughout the year depending on if the patient’s most recent BP reading is greater than 140/90 mmHG. As we start a new year, it’s important that we have record of your patients’ blood pressure readings and that you continue to monitor patients with elevated readings.

 

Tips when scheduling members to close CBP care gaps:

  • When scheduling appointments, have staff ask patients to avoid caffeine and nicotine for at least an hour before their scheduled appointment time.
  • If possible, update your scheduling app and/or your reminder text message campaigns to include reminders about abstaining from caffeine and nicotine prior to appointment time as well as a reminder to arrive early to avoid a sense of rushing.

 

Tips for lower BP readings during the appointment:

  • Ask the patient if they tend to get nervous at appointments and have higher readings as a result. If they do, take their blood pressure at both the start and end of the appointment and document the lower reading.
  • Readings can also vary arm to arm. If slightly elevated in one arm, try the other and document the lower reading.


Getting credit for adequately controlled blood pressure readings:

  • Submit readings via Category II CPT® codes on claims.

    Description

    Code

    Diastolic BP

    CAT II: 3078F-3080F

    LOINC: 8462-4

    Diastolic 80 to 89

    CAT II: 3079F

    Diastolic greater than/equal to 90

    CAT II: 3080F

    Diastolic less than 80

    CAT II: 3078F

    Systolic BP

    CAT II: 3074F, 3075F, 3077F

    LOINC: 8480-6

    Systolic greater than/equal to 140

    CAT II: 3077F

    Systolic less than 140

    CAT II: 3074F, 3075F
  • Ensure readings are carefully and appropriately documented within your electronic medical record system.
  • If you have questions on how to submit readings, speak to your care or practice consultant.
  • Also, be sure to adequately code patients who meet the exclusion criteria:
    • Exclusions:
      • Palliative care
      • Enrolled in hospice
      • Frailty and/or advanced illness
      • Living in long-term care
    • Optional exclusions:
      • Dialysis (ESRD), kidney transplant, nephrectomy
      • Female members with a diagnosis of pregnancy
      • Non-acute inpatient admissions

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).

 

NYBCBS-CM-012301-22-CPN10532


Featured In:
February 2023 Newsletter