PQRS Measure 235 Causes Rejections

An error related to the submission of measure 235 “Hypertension: Plan of Care” for the 2012 Physician Quality Reporting System (PQRS) is causing Medicare Part B claims containing the codes associated with the claims/registry measure to be rejected or denied, according to jurisdiction 1 Medicare administrative contractor (J1-MAC) Palmetto GBA.

This situation began when the six HCPCS Level II G codes and one CPT® Category II code associated with measure 235 were erroneously inactivated in a prior update. The affected codes are:

G8675 Most recent systolic blood pressure >= 140 mm hg
G8676 Most recent diastolic blood pressure >= 90 mm hg
G8677 Most recent systolic blood pressure < 130 mm hg
G8678 Most recent systolic blood pressure 130 to 139 mm hg
G8679 Most recent diastolic blood pressure < 80 mm hg
G8680 Most recent diastolic blood pressure 80 – 89 mm hg

CPT® II 4050F Hypertension plan of care documented as appropriate (HTN)

Until these codes are reactivated in the April 2012 update, the Centers for Medicare & Medicaid Services (CMS) is recommending that eligible providers who intend to report measure 235 via claims for the 2012 PQRS take the following action:

  • Consider reporting an additional measure to substitute for measure 235; or
  • Report measure 235 on more than the required 50 percent of eligible visits from April through December 2012 to increase the likelihood for successful reporting.

Source: Palmetto GBA, March 21, 2012

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