Controlling High Blood Pressure (CBP)

What Is the Measure?

This measure looks at the percentage of enrolled patients 18 to 85 years of age with a diagnosis of hypertension reported on an outpatient claim and whose blood pressure is adequately controlled. Blood pressure control is defined as having the most recent blood pressure below 140/90 mmHg during the measurement year.

In reference to the numerator element, only blood pressure readings performed by a clinician or a remote monitoring device are acceptable for numerator compliance with this measure. The patient must be part of an outpatient visit, telephone visit, e-visit or virtual check-in for the BP reading to count.

Eligible Codes

• It is required that you document the date and most recent results of the blood pressure readings and use the codes above based on BP ranges.

Exclusions

• Evidence of end-stage renal disease (ESRD), dialysis, nephrectomy or renal transplant before or during the measurement period

• Diagnosis of pregnancy during the measurement period

• Patients 66 years of age and older who are either enrolled in an institutional special needs pans (I-SNP) or living long-term in an institution

• Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND a dispensed medication for dementia (cholinesterase inhibitors or miscellaneous central nervous system agents) during the measurement period or the year prior to the measurement period

• Patients 66 years of age and older with at least one claim/encounter for frailty during the measurement period AND either one acute inpatient encounter with a diagnosis of advanced illness or two outpatient, observation, ED or non-acute inpatient encounters on different dates of service with an advanced illness diagnosis during the measurement period or the year prior to the measurement period

How to Improve Score

• Include appropriate CPTII codes when submitting claims.

• Counsel patients to take their blood pressure medication as prescribed and not to skip doses or discontinue unless advised to do so by their provider.

• Encourage patients to obtain a home blood pressure monitor. This may be covered under the member’s insurance benefit in some cases. If so, an order/prescription will be required for coverage.

• If no blood pressure is recorded during the measurement period, the patient’s blood pressure is assumed “not controlled.”

• In your office, if your team records a BP that is out of range,(higher than 140/90) the BP should be repeated and if the original and repeat are still high, the provider should be notified.

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