Quality
P
1 Fev, 2022

Hints for HEDIS® (and more)

CPT® Category II codes can help close care gaps

Using the proper Current Procedural Terminology (CPT) Category II codes when filing claims may help you streamline your administrative processes and close gaps in care. CPT II codes are tracked for certain performance measures, including Healthcare Effectiveness Data and Information Set (HEDIS®) measures from the National Committee for Quality Assurance (NCQA). We use these measures to help monitor and improve the quality of care our members receive.

CPT II codes are more specific than CPT I codes and can help:

  • Provide more accurate medical data and decrease requests for members’ records for review
  • Identify and close gaps in care more accurately and quickly – this drives HEDIS measures and quality improvement initiatives
  • Track member screenings to help you monitor care and avoid sending unnecessary reminders

CPT II codes can be submitted on claims with other applicable codes.

CPT II coding example for Controlling High Blood Pressure

*Remember to include the office visit code, appropriate diagnosis code, and the corresponding CPT II codes on the date the office visit and blood pressure reading took place.

HEDIS measure
Description
Applicable codes
Controlling High Blood Pressure (CBP)
Members ages 18-85 with a diagnosis of hypertension (HTN) and BP adequately controlled at less than 140/90 mmHg or less during the measurement year
A diagnosis of Essential Hypertension and last blood pressure reading in 2021 should be documented in the medical record.
Hypertension diagnosis:
  • ICD-10-CM - I10, I11.9, I12.9, I13.10 (Essential Hypertension)
  • CPT II - 3074F (systolic < 130 mmHg)
    3075F (systolic = 130-139 mmHg)
    3077F (systolic > 140 mmHg)
    3078F (diastolic < 80 mmHg)
    3079F (diastolic = 80-89 mmHg)
    3080F (diastolic > 90 mmHg)
Remote BP monitoring:
CPT – 93784, 93788, 93790, 99091

Additional measure information

Controlling High Blood Pressure-This measure evaluates the percentage of members 18-85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (<140/90 mm Hg).

Step 1: Determine the qualifying codes for eligibility

  1. Diagnosis code for hypertension – (ICD10)
  2. Office visit code (see table A below)

c.   Date of encounter* = date of the office visit and when the blood pressure was obtained

* Remote blood pressure readings can be submitted with telehealth visits.

Step 2: Indicate applicable code

CPT Category II code for each office visit:

CPT II code
Most recent systolic blood pressure
3074F
<130 mm Hg
3075F
130-139 mm Hg
3077F
>= 140 mm Hg
CPT II code
Most recent diastolic blood pressure
3078F
<80 mm Hg
3079F
80-89 mm Hg
3080F
>= 90 mm Hg

Best practice tips: Include all blood pressure readings and the dates they were obtained. Take it twice. If the patient has a high blood pressure reading at the start of the visit, retake and record the reading at the end of the visit. Consider switching arms for subsequent readings.

Please reach out to your quality representative, or email QualityHEDIS@bcbsri.org with any questions or concerns.

Back to Provider Update