The National Committee for Quality Assurance (NCQA) has released updated 2019 Technical Specifications for the Healthcare Effective Data Information Set (HEDIS) for Controlling High Blood Pressure (CBP) measure. HEDIS is a nationally recognized tool that measures health plans, like ConnectiCare, on the performance of the services and care our members receive.
NCQA is now allowing the addition of administrative specifications for measuring compliance for CBP. This change could significantly reduce the burden on providers and health plans during the HEDIS medical record review season.
Providers can now use automated data to identify the most recent BP reading taken during an outpatient visit, a non-acute inpatient encounter or remote monitoring event during the measurement year. The member is considered to be numerator compliant if the corresponding CPT II codes billed equate to <140/90 (please see below). These changes will provide a more accurate and timely accounting of blood pressure control.
Below is a list of the applicable revisions to the CBP measure that you need to be aware of:
- Added administrative specifications which allows for providers to bill CPT codes related to blood pressure values.
Blood pressure value Code system Code Diastolic 80-89 CPT - CAT-II 3079F Diastolic greater than/equal to 90 CPT - CAT-II 3080F Diastolic less than 80 CPT - CAT-II 3078F Systolic 139-139 CPT - CAT-II 3075F Systolic greater than/equal to 140 CPT - CAT-II 3077F Systolic less than 130 CPT - CAT-II 3074F
- Updated blood pressure thresholds to be less than 140/90 for all members, regardless of age or diabetes diagnosis. This change aligns with the American Heart Association’s clinical recommendations to more accurately assess hypertension.
- Removed the medical record confirmation of the hypertension diagnosis and replaced it with two outpatient visits with a hypertension diagnosis during the measurement year or the year prior to the measurement year.
- Added blood pressure readings taken from remote patient monitoring devices that are electronically submitted directly to the provider for numerator compliance.
Please refer to the HEDIS® 2019 Tech Specs for detailed information or contact our Quality Department at 860-409-2491