PIPE Blood Pressure Appointment Type guidance

MNCM collects an Appointment Type field to align with NCQA’s guidance for blood pressures that can be used for measurement in determining hypertension control. NCQA’s listed exemptions for blood pressure values have some that are more straightforward (e.g., That occur during an inpatient stay or an ED visit) and some that are more nuanced and not readily available in structured fields. Below is some additional guidance for the Appointment Type field.  Either option can be applied or used in combination. Please note that only blood pressures submitted with appointment type 3 will be used for clinical quality measure calculations. 

For consistency, MNCM prefers option 1 Encounter CPT + Patient Reported

1. Encounter CPT + Patient Reported 

Use the NCQA outpatient CPT code set (below) to identify encounter types in which qualifying readings occur, enter code 3=other. 

• Need to accommodate patient reported blood pressures which may not have an applicable visit code. MNCM suggests logic that matches the identified code set for visits and then assigns a code 3 = other for all patient reported blood pressures recorded the medical record regardless of the presence of a visit code
• If the blood pressure does not meet either of these instances, then leave the appointment type blank and PIPE will be able to exclude those readings when calculating the diabetes and vascular measures.

Use logic to identify specific departments (e.g., surgical, specified diagnostic testing), and use the provided department mapping to indicate the correct appointment type.