Focus on HEDIS^®: Managing patients with high blood pressure

Hypertension is among the most common conditions seen in the primary care setting. If left untreated, it can lead to myocardial infarction, stroke, renal failure and even death.

Controlling your patient’s blood pressure involves more than taking regular blood pressure readings. Encouraging and coaching your patient to adopt healthy lifestyle habits is an important part of both preventing and controlling high blood pressure.

Adequate blood pressure control is defined as:

• Patients age 18 to 59 whose blood pressure was under 140/90
• Patients age 60 to 85 years of age with a diagnosis of diabetes whose blood pressure was less than 140/90
• Patients age 60 to 85 without a diagnosis of diabetes whose blood pressure was less than 150/90

Do not round manual blood pressure readings. Rounding just a few points can make a patient cross the line from controlled to uncontrolled.

Here are several important things to keep in mind when caring for your hypertensive patients:

• To confirm diagnosis of hypertension, a notation of hypertension must appear in the medical record during an outpatient visit on or before June 30 of each year.
  
• Examples of notation include: Hypertension, HTN, High BP, Elevated BP, Borderline HTN, Intermittent HTN, History of HTN, Hypertensive vascular disease, Hyperpiesia or Hyperpiesis.
• A representative blood pressure is the most recent blood pressure reading taken during the measurement year (by Dec. 31) and it occurs after the date of service in which the diagnosis of hypertension occurred. If multiple readings occur in a single visit, the lowest systolic and lowest diastolic is the representative blood pressure and determines blood pressure control.
  
  
• A blood pressure reading must have been taken and documented in the chart during the same visit in which you assessed the patient for hypertension and again at subsequent visits.
  
  
• Self-reported blood pressure readings taken by your patient aren’t considered acceptable for a diagnosis of hypertension.

For diabetic patients:

If lifestyle changes alone aren’t effective in keeping your diabetic patient’s blood pressure controlled, it may be necessary to add anti-hypertensive medications to the patient’s regimen. Best practice for patients who have hypertension associated with diabetes is to initiate pharmacologic anti-hypertensive treatment that includes an angiotensin converting enzyme inhibitor or angiotensin receptor blocker if no specific contraindications.

Be sure to educate your patient about the importance of taking their recommended medications regularly. You should also discuss possible medication side effects.

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

None of the information included herein is intended to be legal advice and as such it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with all applicable state and federal laws and regulations.