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

Last updated: July 12, 2017

CMS Measure ID: CMS69v5
Version: 5
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 18 years and older BMI => 18.5 and < 25 kg/m2

Initial Patient Population:

All patients 18 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:

Patients who are pregnant

Patients receiving palliative care

Patients who refuse measurement of height and/or weight or refuse follow-up

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:

Patients with a documented Medical Reason:

  • 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
  • Patients in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status
Measure Steward: Centers for Medicare & Medicaid Services (CMS)
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
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.
  • 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.
  • Review the exclusions criteria to determine those patients that BMI measurement may not be appropriate or necessary.

Follow-Up Plan Guidance:

  • 1. 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).

Variation has been noted in studies exploring optimal BMI ranges for the elderly (see Donini et al., (2012); Holme and Tonstad (2015); and Diehr et al. (2008). Notably however, all these studies have arrived at ranges that differ from the standard range for ages 18 and older, which is >=18.5 and < 25 kg/m2. For instance, both Donini et al. (2012) and Holme and Tonstad (2015) reported findings that suggest that higher BMI (higher than the upper end of 25kg/m2) in the elderly may be beneficial. Similarly, worse outcomes have been associated with being underweight (at a threshold higher than 18.5 kg/m2) at age 65 (Diehr et al. 2008). Because of optimal BMI range variation recommendations from these studies, no specific optimal BMI range for the elderly is used. However, It may be appropriate to exempt certain patients from a follow-up plan by applying the exception criteria. Review the following to apply the Medical Reason exception criteria:

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
  • Patients in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status
Addendum Notes: ICD-10 Value Set addition
Quality ID: 128
High Priority Measure: No
Data Submission Method: Claims,CMS Web Interface,EHR,Registry
Specialty Measure Set: Internal Medicine,Cardiology,Gastroenterology,General Surgery,Hospitalists,Neurology,Obstetrics/Gynecology,Orthopedic Surgery,Otolaryngology,Physical Medicine,Preventive Medicine,Rheumatology,Vascular Surgery,Mental/Behavioral Health,Plastic Surgery,General Practice/Family Medicine

Specifications

Release Notes

Header

  • Updated Clinical recommendations with information on treatment of older populations.

    Section: Clinical Recommendation Statement

    Source: Expert Work Group Review

  • Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Added exceptions to the measure specifications, including medical reasons for not performing indicated follow-up plan.

    Section: Denominator Exceptions

    Source: Expert Work Group Review

  • Updated to reflect the change in measure specifications to one Initial Population. Removed Medical reason for exclusion.

    Section: Denominator Exclusions

    Source: Expert Work Group Review

  • Updated measure description to align with clinical guidelines by removing separate population criteria for patients age 65 and older.

    Section: Description

    Source: Expert Work Group Review

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Annual Update

  • Updated Guidance to address elderly population.

    Section: Guidance

    Source: Expert Work Group Review

  • Updated Initial Population to align with clinical guidelines by removing separate population criteria for patients age 65 and older.

    Section: Initial Population

    Source: Expert Work Group Review

  • Updated Rationale with most recent literature review.

    Section: Rationale

    Source: Expert Work Group Review

  • Updated.

    Section: Reference

    Source: Expert Work Group Review

Logic

  • Added medical reason exception for interventions and medication order.

    Section: Denominator Exceptions

    Source: Expert Work Group Review

  • Changed QDM category for Palliative Care exclusion from Procedure to Intervention for harmonization with other like MU measures.

    Section: Denominator Exclusions

    Source: JIRA (CQM-1546)

  • Removed medical reason exclusion.

    Section: Denominator Exclusions

    Source: Expert Work Group Review

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Denominator Exclusions

    Source: QDM Standards

  • Removed Population Criteria 2 from measure; Updated Initial Population for Population Criteria 1 by removing the upper age limit.

    Section: Initial Population

    Source: Expert Work Group Review

  • Changed QDM category for Palliative Care exclusion from Procedure to Intervention for harmonization with other like MU measures.

    Section: QDM Data Elements

    Source: JIRA (CQM-1546)

  • Replaced datatypes 'Diagnosis, Active; Diagnosis, Inactive; Diagnosis, Resolved' with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

Value Set

  • Value set BMI Encounter Code Set (2.16.840.1.113883.3.600.1.1751): Deleted 1 CPT code (90839).

    Section: None

    Source: None

  • Value set Overweight (2.16.840.1.113883.3.600.2387): Added 1 SNOMEDCT code (414916001).

    Section: None

    Source: JIRA (CQM-1642)

  • Value set Pregnancy Dx (2.16.840.1.113883.3.600.1.1623): Added 63 ICD10CM codes and deleted 8 ICD10CM codes (O00.0, O00.1, O00.2, O00.8, O00.9, O33.7, O34.21, O70.2).

    Section: None

    Source: ICD-10 Addendum

External Resources