Helping you improve your scores, as you improve the health of your patients.

Healthcare Effectiveness Data and Information Set (HEDIS®) scores are not only important for you as a provider; they also help guide your patients to quality care. As your trusted partner with the mutual goal of helping people lead healthier lives, Cigna is happy to provide support in every way we can. Use this quick reference guide for tips and up-to-date procedure codes that will help you maintain and even improve your HEDIS scores.

What you need to know

• Controlling high blood pressure looks at patients 18-85 years of age who have a diagnosis of hypertension (HTN) and whose blood pressure (BP) was adequately controlled in a calendar year.
• To be considered under control, the reading must be:
  • For patients 18–59 years of age whose BP was <140/90 mm Hg.
  • For patients 60–85 years of age with a diagnosis of diabetes whose BP was <140/90 mm Hg.
  • For patients 60–85 years of age without a diagnosis of diabetes whose BP was <150/90 mm Hg.
• When an office submits a patient claim to Cigna with a diagnosis of hypertension (diagnosis code 401), this patient will be identified as having hypertension for the purposes of HEDIS.
• For patients who have not previously been diagnosed with hypertension, consider using other diagnosis codes such as 796.2 ("...used to record an episode of elevated blood pressure in a patient in whom no formal diagnosis of hypertension has been made, or as an incidental finding"*) for the following reasons:
  • Rule out hypertension
  • Possible hypertension
  • White coat hypertension
  • Questionable hypertension
• HEDIS relies on diagnoses and procedure codes, as well as patient medical records, to measure performance.

Tips for improving your scores

• Consider the following to assure your patient's blood pressure is under control:
  • Review hypertensive medication history and patient compliance.
  • Take two separate readings at each office visit; many times a second BP reading is lower.
  • Send reminder letters or make reminder calls to patients to keep their appointments.
• Check to make sure your blood pressure cuffs were calibrated within an appropriate time period.
• Offer a refresher course to your staff on taking blood pressure to ensure it's performed and read correctly.

Common billing codes accepted by HEDIS® for controlling blood pressure.

International Classification of Diseases –9th Edition (ICD-9)	International Classification of Diseases –10th Edition (ICD-10)
401	I10
401.1
404.9

<sup>Billing and medical record documentation should always support the level of service provided at that visit.
®HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA)

Reproduced with permission from HEDIS 2017, Volume 2: Technical Specifications for Health Plans by the National Committee for Quality Assurance (NCQA). HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA). To purchase copies of this publication, contact NCQA Customer Support at 888-275-7585 or visit www.ncqa.org/publications.
Current Procedural Terminology (CPT) codes copyright 2016 American Medical Association. All rights reserved. CPT is a trademark of the AMA. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply togovernment use.
Uniform Bill Codes (“UB Codes”) are protected under federal copyright laws and are owned by the American Hospital Association (AHA). The UB Codes in the HEDIS specifications are included with the permission of the AHA. The UB Codes contained in the HEDIS specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting HEDIS results or using HEDIS measure results for their internal quality improvement purposes. All other uses of the UB Codes require a license from the AHA. Software vendors and all others desiring to use the UB Codes in a commercial product to generate HEDIS results, or for any other use, must obtain a commercial use license directly from the AHA. To inquire about licensing, please contact ub04@healthforum.com.</sup>