#128: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

Quality ID

128

eMeasure ID

CMS69v6

NQF

0421

High Priority Measure

No

Specifications

EHR Registry

Measure Type

Process

Specialty

Cardiology Family Medicine Gastroenterology General Surgery Infectious Disease Internal Medicine Mental/Behavioral Health Obstetrics/Gynecology Orthopedic Surgery Otolaryngology Physical Medicine Podiatry Preventive Medicine Rheumatology Urology Vascular Surgery

Measure description

Percentage of patients aged 18 years and older with a BMI documented during the current encounter or duringthe previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented duringthe encounter or during the previous twelve months of the current encounter

Normal Parameters:
Age 18 years and older BMI ≥ 18.5 and < 25 kg/m2

 

Instructions

There is no diagnosis associated with this measure. This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided at the time of the qualifying visit and the measure-specific denominator coding. The BMI may be documented in the medical record of the provider or in outside medical records obtained by the provider. If the most recent documented BMI is outside of normal parameters, then a follow-up plan must be documented during the encounter or during the previous twelve months of the current encounter. The documented follow-up plan must be based on the most recent documented BMI outside of normal parameters, example: “Patient referred to nutrition counseling for BMI above or below normal parameters” (See Definitions for examples of follow-up plan treatments). If more than one BMI is submitted during themeasurement period, the most recent BMI will be used to determine if the performance has beenmet.

Measure Submission:

The listed denominator criteria is used to identify the intended patient population. The numerator options included in this specification are used to submit the quality actions allowed by the measure. The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.

 

Denominator

All patients aged 18 and older on the date of the encounter with at least one eligible encounter during the measurement period

DENOMINATOR NOTE: *Signifies that this CPT Category I code is a non-covered service under the Medicare Part B Physician Fee Schedule (PFS). These non-covered services should be counted in the denominator population for registry-based measures.

Denominator Criteria (Eligible Cases):

Patients aged ≥18 years on date of encounter

AND

Patient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 96150, 96151, 96152, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, D7140, D7210, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447 

WITHOUT

Telehealth Modifier: GQ, GT, 95, POS 02

AND NOT

DENOMINATOR EXCLUSIONS:

BMI not documented, documentation the patient is not eligible for BMI calculation: G8422

OR

BMI is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible: G8938

 

Numerator

Patients with a documented BMI during the encounter or during the previous twelve months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter

Numerator Instructions:

  • Height and Weight - An eligible professional or their staff is required to measure both height andweight. Both height and weight must be measured within twelve months of the current encounter and may be obtained from separate encounters. Self-reported values cannot be used.
  • Follow-Up Plan – If the most recent documented BMI is outside of normal parameters, then a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter. The documented follow-up plan must be based on the most recent documented BMI, outside of normal parameters, example: “Patient referred to nutrition counseling for BMI above or below normal parameters”. (See Definitions for examples of follow-up plan treatments).
  • Performance Met for G8417 & G8418
    • If the provider documents a BMI and a follow-up plan at the current visit OR
    • If the patient has a documented BMI within the previous twelve months of the current encounter, the provider documents a follow-up plan at the current visit OR
    • If the patient has a documented BMI within the previous twelve months of the current encounter AND the patient has a documented follow-up plan for a BMI outside normal parameters within the previoustwelve months of the current visit

Definitions:

BMI – Body mass index (BMI), is a number calculated using the Quetelet index: weight divided byheight squared (W/H2) and is commonly used to classify weight categories. BMI can be calculated using:

Metric Units: BMI = Weight (kg) / (Height (m) x Height (m))

OR

English Units: BMI = Weight (lbs) / (Height (in) x Height (in)) x 703

Follow-Up Plan – Proposed outline of treatment to be conducted as a result of a BMI outside of normal parameters. A follow-up plan may include, but is not limited to:

  • Documentation of education
  • Referral (for example a registered dietitian, nutritionist, occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professional, or surgeon)
  • Pharmacological interventions
  • Dietary supplements
  • Exercise counseling
  • Nutrition counseling

Not Eligible for BMI Calculation or Follow-Up Plan (Denominator Exclusion) – A patient is not eligible if one or more of the following reasons are documented:

  • Patients receiving palliative care on the date of the current encounter or any time prior to the current encounter
  • Patients who are pregnant any time during the measurement year
  • Patients who refuse measurement of height and/or weight or refuse follow-up any time during the measurement period (Jan 1, 2017 – Dec 31, 2017).

Patients with a documented BMI outside normal limits and a documented reason for not completing BMI follow-up plan during the current encounter or within the previous 12 months of the current encounter (Denominator Exception) –

  • The Medical Reason exception could include, but is not limited to, the following patients as deemed appropriate by the health care provider
    • Elderly Patients (65 or older) for whom weight reduction/weight gain would complicate other underlying health conditions such as the following examples:
      • Illness or physical disability
      • Mental illness, dementia, confusion
      • Nutritional deficiency, such as vitamin/mineral deficiency
    • Patient is in an urgent or emergent medical situation where time is of the essence, and to delay treatment would jeopardize the patient’s health status

Numerator Options:

Performance Met: BMI is documented within normal parameters and no follow-up plan is required (G8420)

OR

Performance Met: BMI is documented as above normal parameters and a follow-up plan is documented (G8417)

OR

Performance Met: BMI is documented as below normal parameters and a follow-up plan is documented (G8418)

OR

Denominator Exception: BMI is documented as being outside of normal limits, follow-up plan is not completed for documented reason (G9716)

OR

Performance Not Met: BMI not documented and no reason is given (G8421)

OR

Performance Not Met: BMI documented outside of normal parameters, no follow-up plan documented, no reason given (G8419)

Register with MDinteractive