How to comply with HEDIS^® measure for controlling high blood pressure

Accurate blood pressure readings mean more personalized care, which can help patients better reach their goals for controlling high blood pressure.

The Centers for Medicare & Medicaid Services uses the Healthcare Effectiveness Data and Information Set to measure health care quality. The HEDIS measure for controlling high blood pressure includes patients who:

• Are ages 18 to 85 as of Dec. 31 of the measurement year
• Have a diagnosis of hypertension

A member is compliant if his or her last blood pressure reading of the year is in control.

How is a patient included in the measure?

The patient must have at least one outpatient visit claim with a diagnosis of hypertension on or before June 30 of the measurement year. Patients diagnosed with hypertension in prior years aren’t automatically eligible for the measure. They must meet the inclusion criteria each year.

Patients are excluded from the measure if they:

• Have evidence of end stage renal disease or had a kidney transplant or dialysis on or prior to Dec. 31 of the measurement year
• Have a diagnosis of pregnancy during the measurement year
• Have a non-acute inpatient admission during the measurement year
• Are in hospice at any point in the measurement year

What are the criteria for blood pressure control?

Although the American Heart Association and the American College of Cardiology have recently updated their blood pressure guidelines, the 2017 HEDIS criteria for controlling blood pressure control are:

• < 140/90 (139/89 or less) for patients ages 18 to 59
• < 140/90 (139/89 or less) for patients ages 60 to 85 with diabetes
• < 150/90 (149/89 or less) for patients ages 60 to 85 without diabetes

Readings may be higher at the beginning of the office visit, so take another reading at the end of the visit as it may be lower. It’s important to not round up readings.

Submit blood pressure CPT II codes on each office visit claim

HEDIS requires a medical record review to determine blood pressure compliance. However, when you submit blood pressure CPT Category II codes, it will help support member-facing programs and outcomes:

• 3074F — Most recent systolic blood pressure < 130 mm Hg
• 3075F — Most recent systolic blood pressure 130 – 139 mm Hg
• 3077F — Most recent systolic blood pressure > 140 mm Hg
• 3078F — Most recent diastolic blood pressure < 80 mm Hg
• 3079F — Most recent diastolic blood pressure 80 – 89 mm Hg
• 3080F — Most recent diastolic blood pressure > 90 mm Hg

Questions about HEDIS compliance? Visit bcbsm.com/providers for additional resources.

HEDIS^® is a registered trademark of the National Committee for Quality Assurance.