MACRA Monday: Screening for hypertension


If you haven’t started reporting quality data for the Merit-Based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.

Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.

Consider this measure:

Measure #317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

This measure is aimed at capturing the percentage of patients aged 18 years and older who were screened for high blood pressure and given a follow-up plan.

What you need to do: Check the patient’s blood pressure and recommend follow-up care – lifestyle modifications, additional testing, or medication, as appropriate – and document that plan.

Eligible cases include patients aged 18 years and older on the date of the encounter and a patient encounter during the performance period. Applicable codes include (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 90845, 90880, 92002, 92004, 92012, 92014, 96118, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99281, 99282, 99283, 99284, 99285, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, D7140, D7210, G0101, G0402, G0438, G0439 without telehealth modifier: GQ or GT.

To get credit under MIPS, be sure to include a QDC that shows that you successfully performed the measure or had a good reason for not doing so. For instance, code G8783 indicates that a normal blood pressure reading was documented and follow-up is not required, while code G8950 indicates that the patient had a pre-hypertensive or hypertensive blood pressure reading documented and the appropriate follow-up was documented. Exclusion code G9744 should be used if the patient is not eligible due to an active diagnosis of hypertension.

CMS has a full list measures available for claims-based reporting at The American Medical Association has also created a step-by-step guide for reporting on one quality measure.

Certain clinicians are exempt from reporting and do not face a penalty under MIPS:

  • Those who enrolled in Medicare for the first time during a performance period.
  • Those who have Medicare Part B allowed charges of $30,000 or less.
  • Those who have 100 or fewer Medicare Part B patients.
  • Those who are significantly participating in an Advanced Alternative Payment Model (APM).

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