The Healthcare Effectiveness Data and Information Set (HEDIS®) review for Controlling High Blood Pressure (CBP) consists of a random selection of members 18-85 years of age with a confirmation of a hypertension diagnosis on or before June 30, 2015 and documentation of the most recent blood pressure reading(s) in 2015 after the diagnosis of hypertension.
Notation of adequate control of blood pressure during 2015 is based on the following criteria:
• Members 18-59 years of age whose BP was <140/90 mm Hg.
• Members 60-85 years of age with a diagnosis of diabetes whose BP was <140/90 mm Hg.
• Members 60-85 years of age without a diagnosis of diabetes whose BP was <150/90 mm Hg.
Documentation of a diagnosis of diabetes must be provided if applicable to the patient.
Notation indicating a diagnosis of hypertension is acceptable on the following documents (at an outpatient setting):
• Problem list
• Office or progress note
• Subjective, objective, assessment and plan (SOAP) note
• Encounter form
• Diagnostic report
• Hospital discharge summary
Documentation of hypertension must include one of the following notations:
• Elevated BP (↑BP)
• High BP (HBP)
• Borderline HTN
• Intermittent HTN
• History of HTN
• Hypertensive vascular disease (HVD)
The following statements are not sufficient to confirm a hypertension diagnosis:
• Rule out HTN
• Possible HTN
• White-coat HTN
• Questionable HTN
• Consistent with HTN
BP reading is not acceptable in the following settings:
• Acute inpatient stay or an emergency department visit
• Outpatient visit (diagnostic test or surgical procedure performed (e.g., colonoscopy, removal of a skin lesion))
• Same day of a major diagnostic or surgical procedure (e.g., EKG/ECG, stress test, IV contrast for a radiology procedure, endoscopy).
• Self reported by the member
Source: NCQA HEDIS 2016 Technical Specifications