Hypertension G-Codes Causing Claim Denials


The Centers for Medicare & Medicaid Services (CMS) has identified an error related to the submission of measure No. 235, Hypertension: Plan of Care, for the 2012 Physician Quality Reporting System (PQRS). Hypertension: Plan of Care is a claims/registry measure with G-codes that are inactive due to an error. Consequently, Medicare carrier TrailBlazer has rejected or denied claims containing the G-codes associated with the measure.

 CMS will reactivate the codes G8675, G8676, G8677, G8678, G8679, G8680, and 4050F with its next update of the HCPCS code data in April 2012. For 2012 claims-based reporting, PQRS requires at least three measures be reported at a 50-percent reporting rate.

In the interim, if you had intended to report this measure via claims for the 2012 PQRS, consider doing the following:

  • Report additional measures to substitute for measure No. 235, Hypertension: Plan of Care.
  • Hypertension: Plan of Care is a per-visit measure, which requires reporting for 50 percent of eligible patient visits. Therefore, you could report the measure on more than 50 percent of eligible visits from April through December 2012 to increase the likelihood for successful reporting of the measure.

As an alternative to reporting PQRS quality measures via claims, physicians can report using aqualified registry (PDF). TMA endorses two such vendors. Or, practices can submit measures using a qualified electronic health record (PDF).

 Published March 16, 2012 

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