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CMS 165v11

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      ​Thank you for your inquiry regarding CMS165v11, Controlling High Blood Pressure (2023 performance period), pertaining to the removal of the following guidance: "Do not include BP readings... Taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests."

      In previous versions, colonoscopy and infusions are examples that may require a change in diet and/or medication; therefore, BPs taken at visits for these tests/procedures should not meet criteria. This guidance has been phased out in version 11 because the list of tests/procedures may change depending on the provider and/or patient characteristics and cannot be further specified by the measure logic.

      In version 11, ineligible BPs would be those taken during any acute inpatient stay or an emergency department visit; BPs taken during colonoscopies and infusions would qualify as long as they are not performed during these visits.

      An acute inpatient stay is specified by the codes in the value set "Encounter Inpatient" (https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion/eCQM%20Update%202022-05-05), as defined by the measure logic definitions "Qualifying Systolic Blood Pressure Reading" and "Qualifying Diastolic Blood Pressure Reading". Likewise, an emergency department visit is specified by the codes in the value set "Emergency Department Visit" (https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion/eCQM%20Update%202022-05-05).

      Qualifying Systolic Blood Pressure Reading

      ["Physical Exam, Performed": "Systolic blood pressure"] SystolicBP
      without ( ["Encounter, Performed": "Encounter Inpatient"]
      union ["Encounter, Performed": "Emergency Department Visit"] ) DisqualifyingEncounter
      such that Global."LatestOf" ( SystolicBP.relevantDatetime, SystolicBP.relevantPeriod ) during day of DisqualifyingEncounter.relevantPeriod
      where SystolicBP.result.unit = 'mm[Hg]'
      and Global."LatestOf" ( SystolicBP.relevantDatetime, SystolicBP.relevantPeriod ) during day of "Measurement Period"
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      ​Thank you for your inquiry regarding CMS165v11, Controlling High Blood Pressure (2023 performance period), pertaining to the removal of the following guidance: "Do not include BP readings... Taken on the same day as a diagnostic test or diagnostic or therapeutic procedure that requires a change in diet or change in medication on or one day before the day of the test or procedure, with the exception of fasting blood tests." In previous versions, colonoscopy and infusions are examples that may require a change in diet and/or medication; therefore, BPs taken at visits for these tests/procedures should not meet criteria. This guidance has been phased out in version 11 because the list of tests/procedures may change depending on the provider and/or patient characteristics and cannot be further specified by the measure logic. In version 11, ineligible BPs would be those taken during any acute inpatient stay or an emergency department visit; BPs taken during colonoscopies and infusions would qualify as long as they are not performed during these visits. An acute inpatient stay is specified by the codes in the value set "Encounter Inpatient" ( https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion/eCQM%20Update%202022-05-05), as defined by the measure logic definitions "Qualifying Systolic Blood Pressure Reading" and "Qualifying Diastolic Blood Pressure Reading". Likewise, an emergency department visit is specified by the codes in the value set "Emergency Department Visit" ( https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1010/expansion/eCQM%20Update%202022-05-05 ). Qualifying Systolic Blood Pressure Reading ["Physical Exam, Performed": "Systolic blood pressure"] SystolicBP without ( ["Encounter, Performed": "Encounter Inpatient"] union ["Encounter, Performed": "Emergency Department Visit"] ) DisqualifyingEncounter such that Global."LatestOf" ( SystolicBP.relevantDatetime, SystolicBP.relevantPeriod ) during day of DisqualifyingEncounter.relevantPeriod where SystolicBP.result.unit = 'mm[Hg]' and Global."LatestOf" ( SystolicBP.relevantDatetime, SystolicBP.relevantPeriod ) during day of "Measurement Period"
    • CMS0165v11

      With the change in specifications regarding blood pressure and procedures; are colonoscopies or other procedures that require a medication or diet change and are performed in a hospital outpatient setting or a clinic setting would now count as an acceptable BP for quality measure reporting for the Controlling High BP measure. 

            edave Mathematica EC eCQM Team
            hollerich.amber@mayo.edu Amber Hollerich (Inactive)
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