FAQ Directory: HEDIS

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4.14.2017 Controlling High Blood Pressure Please clarify the instruction to not include BP readings taken on the same day as a diagnostic test or procedure that requires a change in diet or medication. Must the change in diet or medication be required by the procedure? Is the BP eligible if a patient forgets to take their regular medication the day of a procedure? Is the BP eligible if the member receives a vaccine, a nebulizer treatment with albuterol or lidocaine injected prior to an unplanned removal of a small mole?

The intent is to identify diagnostic or therapeutic procedures that require a medication regimen, a change in diet or a change in medication. For example, colonoscopy requires a change in diet (NPO on the day of procedure) and a medication change (a medication is taken to prep the colon). Dialysis, infusions and chemotherapy are all therapeutic procedures that require a medication regimen. A nebulizer treatment with albuterol is considered a therapeutic procedure that requires a medication regimen (the albuterol). Injection of lidocaine prior to mole removal is considered a diagnostic procedure (if the mole is being tested) or a therapeutic procedure (if removal of the mole is the treatment) that requires a change in medication (lidocaine administered for pain control during the procedure). A patient forgetting to take regular medications on the day of the procedure is not considered a required change in medication, and therefore the BP reading is eligible.

 A BP taken on the same day that the patient receives a vaccination is eligible for use. A vaccination is considered preventive medicine and is not considered a therapeutic or diagnostic procedure.

HEDIS 2017