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

Last updated: May 4, 2017

CMS Measure ID: CMS69v4
Version: 4
NQF Number: 0421
Measure Description:

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

Normal Parameters:
Age 65 years and older BMI => 23 and < 30 kg/m2
Age 18 - 64 years BMI => 18.5 and < 25 kg/m2

Initial Patient Population:

There are two (2) Initial Patient Populations for this measure:

Initial Patient Population 1: All patients 18 through 64 years on the date of the encounter with at least one eligible encounter during the measurement period.

Initial Patient Population 2: All patients 65 years of age and older on the date of the encounter with at least one eligible encounter during the measurement period.

Denominator Statement:

Equals Initial Population

Denominator Exclusions:

Initial Patient Population 1: Patients who are pregnant or encounters where the patient is receiving palliative care, refuses measurement of height and/or weight, the 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, or there is any other reason documented in the medical record by the provider explaining why BMI measurement was not appropriate.

Initial Patient Population 2: Encounters where the patient is receiving palliative care, refuses measurement of height and/or weight, the 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, or there is any other reason documented in the medical record by the provider explaining why BMI measurement was not appropriate.

Numerator Statement:

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

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: Centers for Medicare & Medicaid Services
Domain: Community/Population Health
Next Version: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Previous Version: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan
Measure Score: Proportion
Improvement Notation:

Higher score indicates better quality

Guidance:

  • There is no diagnosis associated with this measure.
  • This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period.
  • This measure may be reported by eligible professionals 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.

BMI Measurement Guidance:

  • Height and Weight - An eligible professional or their staff is required to measure both height and weight. Both height and weight must be measured within six months of the current encounter and may be obtained from separate encounters. Self-reported values cannot be used.
  • 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 is documented during the encounter or during the previous six 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 normal parameters. (See Definitions for examples of a follow-up plan treatments).
  • If more than one BMI is reported during the measurement period, the most recent BMI will be used to determine if the performance has been met.

Specifications

Release Notes

Header

  • Copyright updated.
  • Disclaimer updated.
  • eMeasure version number incremented.
  • eMeasure version number incremented from 4.0.000 to 4.1.000.

Logic

  • Changed data type of 'result' or 'finding' to 'performed'.
  • Introduced function 'satisfies all' to specify that qualifying events must meet all conditions from a set of conditions or 'satisfies any' to specify that qualifying events must meet at least one condition from a set of conditions to streamline expression logic.
  • Introduced the new timing operator 'overlaps' to replace two lines of logic (AND/AND NOT) or to enforce when an event or set of events occur to meet the measure intent.
  • Remove logic for pregnancy exclusion from >= 65 or older population (IPP 2).
  • Replaced 'ORs' with 'Union of' operator.
  • Replaced 'Patient Characteristic Birthdate' with 'Age at' operator.
  • Replaced 'starts before or during' (SBOD) with 'starts before end of' (SBE).
  • Updated logic so that palliative care, medical reason not done, and patient reason refused are removed from the IPP and placed in exclusions.

Value Sets

  • Value set BMI Encounter Code Set (OID 2.16.840.1.113883.3.600.1.1751): Added 6 CPT codes (99385, 99386, 99387, 99395, 99396, 99397).
  • Value set Medical or Other reason not done (OID 2.16.840.1.113883.3.600.1.1502): Added code Add code 428119001.
  • Value set Palliative Care (OID 2.16.840.1.113883.3.600.1.1579): Added 4 SNOMED codes (133918004, 182964004,385736008, 385763009).
  • Value set Patient Reason Refused (OID 2.16.840.1.113883.3.600.1.1503): Replaced OID 2.16.840.1.113883.3.600.791 'Patient Reason Refused' in CMS69v4.
  • Value set Pregnancy Dx (OID 2.16.840.1.113883.3.600.1.1623): Deleted 2 SNOMED codes (289908002, 386322007).

XML

  • This measure contains multiple Population Criteria sections. The earlier version of this measure contained mismatches between the applicable Population Criteria human readable narrative sections and their associated computer-readable sections in the XML file. This issue has been corrected.

External Resources