Quality ManagementHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingFebruary 1, 2024

Controlling high blood pressure and HEDIS

The controlling blood pressure (CBP) HEDIS® measure can be challenging. It not only requires proof of a blood pressure (BP) reading but also that the patient’s BP 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 139/89 mmHG. It is important that we have record of your patients’ BP readings and that you schedule any members who have not had a BP reading or who have had high readings recorded this year.

Tips when scheduling members to close CBP care gaps:

  • When scheduling appointments, encourage office staff to ask patients to avoid caffeine and nicotine for at least an hour before their scheduled appointment time.
  • If possible, update your scheduling app or your reminder text message campaigns to include a reminder about abstaining from caffeine 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 BP at both the start and end of the appointment. Document the lower reading.
  • Readings could vary arm to arm. If slightly elevated in one arm, try the other and document the lower reading.

Getting credit for adequately CBP 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 records (EMR) system.
  • If you have questions on how to submit readings, speak to your care consultant or program manager.
  • Be sure to adequately code patients who meet the exclusion criteria.

To learn more about our commitment to health equity, visit My Diverse Patients.

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

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Providers who are contracted with Anthem Blue Cross and Blue Shield to serve Hoosier Healthwise, Healthy Indiana Plan, and Hoosier Care Connect through an accountable care organization (ACO), participating medical group (PMG) or Independent Physician Association (IPA) are to follow guidelines and practices of the group. This includes but is not limited to authorization, covered benefits and services, and claims submittal. If you have questions, please contact your group administrator or your Anthem network representative.

INBCBS-CD-038101-23-CPN37873

PUBLICATIONS: February 2024 Provider Newsletter