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SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
HYPERTENSION MEASURES GROUP OVERVIEW
2013 PQRS OPTIONS FOR MEASURES GROUPS:
REGISTRY ONLY

2013 PQRS MEASURES IN HYPERTENSION MEASURES GROUP:
#295. Hypertension: Appropriate Use of Aspirin or Other Antithrombotic Therapy
#296. Hypertension: Complete Lipid P rofile
#298. Hypertension: Annual Serum Creatinine Test #299. Hypertension: Diabetes Mel itus Screening Test #300. Hypertension: Blood P ressure Control #301. Hypertension: Low Density Lipoprotein (LDL-C) Control #302. Hypertension: Dietary and P hysical Activity Modifications Appropriately P rescribed
INSTRUCTIONS FOR REPORTING: (These instructions apply to registry reporting. Do not report this
measures group via claims.)
� It is not necessary to submit the measures group-specific intent G-code for registry-based submissions. However, the measures group-specific intent G-code has been created for registry only measures groups for use by registries that utilize claims data. G8904: I intend to report the Hypertension (HTN) Measures Group
20 Patient Sample Method: 20 unique patients (a majority of which must be Medicare P art B FFS
[fee for service] patients) meeting patient sample criteria for the measures group during the reporting period (J anuary 1 through December 31, 2013 OR J uly 1 through December 31, 2013).
� Patient sample criteria for the Hypertension Measures Group are patients aged 18 through 90 years with a specific diagnosis of hypertension, and without a diagnosis of stage 5 chronic kidney disease (GFR of < 15ml/min per 1.72 m2 or end-stage kidney disease), accompanied by a specific One of the fol owing diagnosis codes indicating hypertension:
ICD-9-CM: 401.0, 401.1, 401.9, 402.00, 402.01, 402.10, 402.11, 402.90, 402.91, 403.00, 403.10,
403.90, 404.00, 404.01, 404.10, 404.11, 404.90, 404.91 ICD-10-CM [Reference ONLY/Not Reportable]: I10, I11.0, I11.9, I12.9, I13.0, I13.10

Accompanied by

One of the fol owing patient encounter codes:
99201, 99202, 99203, 99204, 99205, 99212,
99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348,
Diagnosis for stage 5 chronic kidney disease:
ICD-9-CM: 403.01, 403.11, 403.91, 404.02, 404.03, 404.12, 404.13, 404.92, 404.93, 585.5, 585.6
ICD-10-CM [Reference ONLY/Not Reportable]: I12.0, I13.11, I13.2, N18.5, N18.6
Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
� Report a numerator option on al applicable measures within the Hypertension Measures Group
for each patient within the eligible professional’s patient sample. � Applicable measures contain patient demographic criteria specific to the measure. For example, Hypertension: Appropriate Use of Aspirin or Other Antithrombotic Therapy criteria is applicable only to patients 30-90 years within the sample population, while al other measures within this group apply to al patients 18-90 years. Reporting measure(s) from the group that are inapplicable to an individual patient wil not af ect the eligible provider’s reporting or performance rate. � Instructions for qualifying numerator option reporting for each of the measures within the Hypertension Measures Group are displayed on the next several pages. The fol owing composite G-code has been created for registry only measures groups for use by registries that utilize claims data. This composite G-code may be reported in lieu of the individual quality-data codes for each of the measures within the group, if al quality actions for the patient have been performed for al the measures within the group. However, it is not necessary to submit the fol owing composite G-code
Composite G-code G8763: Al quality actions for the applicable measures in the Hypertension
(HTN) Measures Group have been performed for this patient � To report satisfactorily the Hypertension Measures Group it requires al measures for each patient
within the eligible professional’s patient sample to be reported a minimum of once during the � Measures groups containing a measure with a 0% performance rate wil not be counted as satisfactorily reporting the measures group. The recommended clinical quality action must be performed on at least one patient for each measure within the measures group reported by the eligible professional. P erformance exclusion quality-data codes are not counted in the performance denominator. If the eligible professional submits al performance exclusion quality-data codes, the performance rate would be 0/0 and would be considered satisfactorily reporting. � When using the 20 Patient Sample Method, report al applicable measures for the 20 unique patients seen a majority of which must be Medicare P art B FFS patients for the 12-month or 6- NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Measure #295: Hypertension: Appropriate Use of Aspirin or Other Antithrombotic Therapy

DESCRIPTION
:
P ercentage of patients aged 30 through 90 years old with a diagnosis of hypertension and are eligible for aspirin or other antithrombotic therapy who were prescribed aspirin or other antithrombotic therapy NUMERATOR:
P atients who were prescribed aspirin or other antithrombotic therapy
Numerator Instructions: Oral antithrombotic therapy consists of aspirin, warfarin, clopidogrel,
dabigatran, rivaroxaban, or combination of aspirin and extended release dipyridamole. Diagnosis of prior coronary heart disease, prior stroke or transient ischemic at ack, prior peripheral artery disease, and/or prior diabetes, and Framingham risk assessment for estimating 10-year risk of developing CHD are used to determine whether a patient should be prescribed/recommended aspirin or other antithrombotic therapy or at low risk and therefore aspirin or other antithrombotic therapy should not be prescribed/recommended. P atients for whom the goals of care are predominantly pal iative or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate, or with low risk for CHD Definition:
Prescribed - May include prescription/recommendation given to the patient for aspirin or other
antithrombotic at one or more visits in the 12 month period OR patient already taking aspirin, warfarin, clopidogrel, dabigatran, rivaroxaban or combination of aspirin and extended release dipyridamole as documented in current medication list. Treatment of hypertension with standard treatment goals is not clinical y appropriate - For
some patients, treatment of hypertension with standard goals may not be relevant, as might be the case for a patient with severe Alzheimer’s disease. Low Risk - NO prior coronary heart disease AND NO prior stroke or transient ischemic at ack,
AND NO prior peripheral artery disease, AND NO prior diabetes, AND 10-year risk of developing CHD less than or equal to 10% as indicated by Framingham risk score and al elements of Framingham risk calculation are complete. Framingham Risk Score - A risk assessment tool which uses recent data from the Framingham
Heart Study to estimate 10-year risk for “hard” coronary heart disease outcomes (myocardial infarction and coronary death). This tool is designed to estimate risk in adults aged 20 and older who do not have heart disease or diabetes.
Numerator Options:
Oral aspirin or other antithrombotic therapy prescribed (G8895)
Documentation of medical reason(s) for not prescribing oral aspirin or other antithrombotic therapy (e.g., patient documented to be low risk, or patient with pal iative care goals or treatment of hypertension with standard treatment goals is not clinical y appropriate, or for whom risk of aspirin or other antithrombotic therapy exceeds potential benefits such as for individuals whose blood pressure is poorly control ed) (G8896)
Oral aspirin or other antithrombotic therapy was not prescribed, reason not given (G8897)
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Measure #296: Hypertension: Complete Lipid Profile

DESCRIPTION
:
P ercentage of patients aged 18 through 90 years old with a diagnosis of hypertension who received a complete lipid profile within 60 months
NUMERATOR:
P atients who received at least one lipid profile (including total cholesterol, HDL-C, triglycerides and calculated LDL-C) within 60 months
Numerator Instruction:
P atients for whom the goals of care are predominantly pal iative or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate should be excluded.
Definitions:

Treatment of hypertension with standard treatment goals is not clinical y appropriate - For
some patients, treatment of hypertension with standard goals may not be relevant, as might be the case for a patient with severe Alzheimer’s disease. NUMERATOR NOTE: The performance period for this measure is 60 months.
Numerator Options:
Lipid panel results documented and reviewed (must include total cholesterol, HDL-C, triglycerides and calculated LDL-C) (G8767)
Note: If LDL-C could not be calculated due to high triglycerides, count as complete lipid profile. Documentation of medical reason(s) for not performing lipid profile (e.g., patients with pal iative goals or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate) (G8768)
Lipid profile not performed, reason not given (G8769)
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Measure #297: Hypertension: Urine Protein Test

DESCRIPTION
:
P ercentage of patients aged 18 through 90 years old with a diagnosis of hypertension who either have chronic kidney disease diagnosis documented or had a urine protein test done within 36 months
NUMERATOR:
P atients who either have chronic kidney disease diagnosis documented OR had a urine protein test done within 36 months

Numerator Instructions:
This measure is looking for a urine protein screening test or evidence of
existing chronic kidney disease. A urine protein test consists of tests for albuminuria, microalbuminuria, or proteinuria. P atients for whom the goals of care are predominantly pal iative or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate
Definitions:

Treatment of hypertension with standard treatment goals is not clinical y appropriate - For
some patients, treatment of hypertension with standard goals may not be relevant, as might be the case for a patient with severe Alzheimer’s disease.
NUMERATOR NOTE: The performance period for this measure is 36 months.
Numerator Options:
Urine P rotein test result documented and reviewed (G8770)
Documentation of diagnosis of chronic kidney disease (G8771)
Documentation of medical reason(s) for not performing urine protein test (e.g., patients with pal iative goals or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate) (G8772)
Urine protein test was not performed, reason not given (G8773)
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Measure #298: Hypertension: Annual Serum Creatinine Test

DESCRIPTION:

P ercentage of patients aged 18 through 90 years old with a diagnosis of hypertension who had a serum creatinine test done within 12 months

NUMERATOR:
P atients who had most recent serum creatinine test done within 12 months
Numerator Instructions: P atients for whom the goals of care are predominantly pal iative or for
whom treatment of hypertension with standard treatment goals is not clinical y appropriate should Definitions:
Treatment of hypertension with standard treatment goals is not clinical y appropriate - For
some patients, treatment of hypertension with standard goals may not be relevant, as might be the case for a patient with severe Alzheimer’s disease.
NUMERATOR NOTE: The performance period for this measure is 12 months.

Numerator Options:
Serum creatinine test result documented and reviewed (G8774)
Documentation of medical reason(s) for not performing serum creatinine test (e.g., patients with pal iative goals or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate) (G8775)
Serum creatinine test not performed, reason not given (G8776)
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Measure #299: Hypertension: Diabetes Mel itus Screening Test

DESCRIPTION:

P ercentage of patients aged 18 through 90 years old with a diagnosis of hypertension who had a diabetes screening test within 36 months
NUMERATOR:
P atients who had a diabetes screening test done within 36 months
Numerator Instructions: Diabetes screening test consists of either a fasting glucose
measurement, glycosylated hemoglobin test, or a two hour glucose tolerance test (three specimens). P atients for whom the goals of care are predominantly pal iative or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate should be excluded. Definitions:
Treatment of hypertension with standard treatment goals is not clinical y appropriate - For
some patients, treatment of hypertension with standard goals may not be relevant, as might be the case for a patient with severe Alzheimer’s disease.
NUMERATOR NOTE: The performance period for this measure is 36 months.
Numerator Options:
Diabetes screening test performed (G8777)
Documentation of medical reason(s) for not performing diabetes screening test (e.g., patients with pal iative goals or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate) (G8778)
Diabetes screening test not performed, reason not given (G8779)
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Measure #300: Hypertension: Blood Pressure Control

DESCRIPTION:

P ercentage of patients aged 18 through 90 years old with a diagnosis of hypertension who had most recent blood pressure level under control (at goal)
NUMERATOR:

P atients who had most recent blood pressure under control Numerator Instructions: P atients are considered to have most recent blood pressure under
control if any of the fol owing are documented: � < 130/80 mmHg for those with chronic kidney disease OR diabetes � < 140/90 mmHg for those without conditions listed above
If there are multiple blood pressures on the same date of service, use the lowest systolic and
lowest diastolic blood pressure on that date as the representative blood pressure. To be “under control”, both systolic and diastolic blood pressures must be below the target values (e.g., for a diabetes patient, systolic BP =136 mmHg and diastolic BP =70 mmHg is not “under control”). P atients for whom the goals of care are predominantly pal iative or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate should be excluded. Definitions:
Treatment of hypertension with standard treatment goals is not clinical y appropriate - For
some patients, treatment of hypertension with standard goals may not be relevant, as might be the case for a patient with severe Alzheimer’s disease. NUMERATOR NOTE: The performance period for this measure is 12 months.
Numerator Options:
Most recent blood pressure under control (G8886)
Documentation of medical reason(s) for most recent blood pressure not being under control (e.g.,
patients with pal iative goals or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate) (G8887)
Most recent blood pressure not under control, results documented and reviewed (G8888)
No documentation of blood pressure measurement, reason not given (G8889)
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Measure #301: Hypertension: Low Density Lipoprotein (LDL-C) Control

DESCRIPTION:


P ercentage of patients aged 18 through 90 years old with a diagnosis of hypertension who had most recent
LDL cholesterol level under control (at goal) NUMERATOR:
P atients who had most recent LDL-C level under control during the 60-month period
Numerator Instructions: P atients are considered to have most recent LDL-C level under control if
� < 100 mg/dL for those with coronary heart disease, OR stroke or transient ischemic at ack, OR peripheral artery disease, OR diabetes � < 130 mg/dL for those without conditions listed above, but with one or more additional risk factors for CHD (Low HDL (< 40 mg/dL) or on HDL-������������������������������������ ��������������������� ����������������������������������������������������������������as a negative risk factor � < 160 mg/dL for those without conditions listed above, and without additional risk factors
for CHD (Low HDL (< 40 mg/dL) or on HDL-���������������������������������������� ����������������� ���������������������������������������������������������������������negative risk factor P atients for whom the goals of care are predominantly pal iative or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate should be excluded. Definitions:
Treatment of hypertension with standard treatment goals is not clinical y appropriate - For
some patients, treatment of hypertension with standard goals may not be relevant, as might be the case for a patient with severe Alzheimer’s disease.
NUMERATOR NOTE: The performance period for this measure is 60 months.
Numerator Options:
Most recent LDL-C under control, results documented and reviewed (G8890)
Documentation of medical reason(s) for most recent LDL-C not under control (e.g., patients with pal iative goals or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate) (G8891)
Documentation of medical reason(s) for not performing LDL-C test (e.g., patients with pal iative goals or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate) (G8892)
Most recent LDL-C not under control, results documented and reviewed (G8893)
LDL-C not performed, reason not given (G8894)
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012 SPECIFICATION FOR MEASURES GROUP REPORTING ONLY
Measure #302: Hypertension: Dietary and Physical Activity Modifications Appropriately
Prescribed

DESCRIPTION:
P ercentage of patients aged 18 through 90 years old with a diagnosis of hypertension who
received dietary and physical activity counseling at least once within 12 months

NUMERATOR:
P atients who received dietary and physical activity counseling at least once within 12 months
Numerator Instructions: P atients for whom the goals of care are predominantly pal iative or for
whom treatment of hypertension with standard treatment goals is not clinical y appropriate should Definitions:
Treatment of hypertension with standard treatment goals is not clinical y appropriate - For
some patients, treatment of hypertension with standard goals may not be relevant, as might be the case for a patient with severe Alzheimer’s disease. Counseling – May include documentation of prescribing any of the fol owing dietary modifications:
dietary saturated fat and cholesterol restriction, calorie restriction as part of weight reduction program for overweight/obese patients, DASH eating plan, dietary sodium restriction, increased fruits, vegetables and/or soluble fiber; and documentation of activity status for active patients or discussion of increase exercise or physical activity for inactive patients.
NUMERATOR NOTE: The performance period for this measure is 12 months.

Numerator Options:
Counseling for Diet and Physical Activity P erformed (G8780)
OR Documentation of medical reason(s) for patient not receiving counseling for diet and physical
activity (e.g., patients with pal iative goals or for whom treatment of hypertension with standard treatment goals is not clinical y appropriate) (G8781)
Documentation of patient reason(s) for patient not receiving counseling for diet and physical activity (e.g., patient is not wil ing to discuss diet or exercise interventions to help control blood pressure, or
the patient said he/she refused to make these changes) (G8949)
Counseling for Diet and Physical Activity not performed, reason not given (G8782)
NOTE: The detailed instructions in this specification apply exclusively to the reporting and analysis of the included measures under the measures groups option. For al other claims-based or registry-based reporting options, please see the measures’ ful specifications in the document “2013 P hysician Quality Reporting System (P QRS) Measure Specifications Manual for Claims and Registry Reporting for Individual Measures” available for download from the CMS P QRS website. Version 6.1 CP T only copyright 2012 American Medical Association. Al rights reserved. 12/19/2012

Source: http://www.mdinteractive.biz/files/uploaded/file/cms2013group/Hypertension_2013_CMS.pdf

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