CMS has released new guidelines for the reporting of blood pressure readings on members. The goal is for systolic blood pressure to be <140, and diastolic blood pressure to be <90. CMS now wishes to see blood pressures reported in the way that providers view them—as the blood pressure that best represents a person’s true readings. That measurement is not necessarily the one the MA gets in the exam room, as we all know. Mr. Smith dislikes coming into medical offices, so his reading is 156/90 in the room, but at home that morning, it was 126/78 before his coffee. Mrs. Jones is on remote patient monitoring at home for her blood pressure and the readings are within ideal rage, but when she comes to the office, she is anxious and the reading is 166/92. Do these scenarios sound familiar? And yet, you as a provider do not want to keep cranking up the antihypertensive doses, because then the next call you will get will be from Mrs., Jones’ husband, who has taken her to the emergency room for a fall caused by her hypotension.
So how can the “most representative blood pressure” be reported without “breaking the rules” per CMS?
The first most important factor is from where the reading is taken. The BP that counts will be the last one in the medical record for the measurement year. Yes, it is only February, but remember, there are actually patients you will see in February and early spring that you may not see again for the rest of the year—so every reading counts!
The second most important factor is the location (in the chart) of the final reading. Readings will be extracted from the Vital Signs section of the chart. Specifically, the BP reading that “counts” is the one in the VS section for the visit. In other words, blood pressures recorded in the Comments section, or the Extended vital signs section of the visit will not count. So, what happens if your MA takes an initial reading and it is high, but she repeats it in 10 minutes and the reading is 138/80? That one needs to go in the Vital Signs and the original one erased. (It can be typed into the Comments section of the Vitals Signs section and labeled as “1st reading” for a complete and accurate record.)
CMS has given us further latitude, however. A provider can choose to record the reading the member got at home that morning before coming to the office, or the reading from the cardiology office that morning, or can even call back to the office later that day and report what the blood pressure was when she got home (just don’t sign off the note beforehand!) If you do Remote Patient Monitoring, you can take the reading from their machine report. You can even take the systolic from one reading and the diastolic from another, as long as both readings were on the same day.
As you can see, CMS is giving us room to provide the most appropriate care to our patients, but we must understand the rules about how and where to document what we see.