Quality ManagementCommercialMedicare AdvantageMedicaidOctober 31, 2023

Controlling high blood pressure and HEDIS

Beginning January 1, 2024, Empire became Anthem. This article, published under the former brand, now applies to Anthem.

This communication applies to Commercial, Medicaid, and Medicare Advantage plans from Empire.

The Controlling Blood Pressure (CBP) HEDIS® measure can be challenging. It not only requires proof of a blood pressure reading, but also that the patient’s blood pressure (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 138/89 mmHG. As we approach the end of the year, 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 during 2023 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. Reference the Healthy BP Recheck Initiative for more information.
  • 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. Please reference our Heart Healthy Diet Conversation Guide to learn more about engaging patients to make lifestyle changes if they’re of a culture different than your own.

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

Medicaid products offered by Empire BlueCross BlueShield HealthPlus, trade name of HealthPlus HP, LLC. Services provided by Empire HealthChoice HMO, Inc., Empire HealthChoice Assurance, Inc., or Empire BlueCross BlueShield Retiree Solutions. Empire BlueCross BlueShield Retiree Solutions is the trade name of Anthem Insurance Companies, Inc. lndependent licensees of the Blue Cross Blue Shield Association, an association of independent Blue Cross Blue Shield plans.

NYBCBS-CDCRCM-038106-23-CPN37873

PUBLICATIONS: November 2023 Provider Newsletter