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

Last updated: May 3, 2018

CMS Measure ID: CMS69v6
Version: 6
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 twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the 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

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 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 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 and Medicaid Services (CMS)
Domain: Community/Population Health
Next Version:
Previous Version:
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 twelve 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 twelve 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

Notes: Value Set content updated Sept 2017

Specifications

Release Notes

Header

  • ​Incremented eMeasure Version number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Modified Measure Developer name from 'Quality Insights of Pennsylvania' to 'Quality Insights.'.

    Measure Section: Measure Developer

    Source of Change: Measure Lead

  • Updated frequency of BMI documented in Description, Guidance, and Numerator to align with guidelines.

    Measure Section: Description

    Source of Change: Expert Work Group Review

  • ​Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • ​​Updated Rationale.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Added intensive behavioral interventions to align with guidelines.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Expert Work Group Review

  • Updated References.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated Guidance.

    Measure Section: Guidance

    Source of Change: Measure Lead

  • Updated frequency of BMI documented in Description, Guidance, and Numerator to align with guidelines.

    Measure Section: Guidance

    Source of Change: Expert Work Group Review

  • Updated frequency of BMI documented in Description, Guidance, and Numerator to align with guidelines.

    Measure Section: Numerator

    Source of Change: Expert Work Group Review

Logic

  • Added 'Encounter, Performed: Palliative care encounter' starts before end of 'Occurrence A of Encounter, Performed: BMI Encounter Code Set' to incorporate new value set with ICD-10 Palliative care encounter (2.16.840.1.113883.3.600.1.1575).

    Measure Section: Denominator Exclusions

    Source of Change: JIRA (CQM-2005)

  • Replaced the 'starts before start of' and 'starts before end of' logical operator for situations in which time stamps are not attached to procedures, diagnosis, and immunizations. Wherever applicable, the operators have been changed to 'starts before or concurrent with start of' or 'starts before or concurrent with end of' respectively.

    Measure Section: Denominator Exclusions

    Source of Change: Measure Lead

  • Deleted attribute 'reason: Overweight' from 'Intervention, Order: Above Normal Follow-up' and 'Medication, Order: Above Normal Medications'; deleted attribute 'reason underweight' from 'Intervention, Order: Below Normal Follow up' and 'Medication, Order: Below Normal Medications' to simplify measure implementation.

    Measure Section: Numerator

    Source of Change: JIRA (CQM-748)

  • Replaced the 'starts before start of' and 'starts before end of' logical operator for situations in which time stamps are not attached to procedures, diagnosis, and immunizations. Wherever applicable, the operators have been changed to 'starts before or concurrent with start of' or 'starts before or concurrent with end of' respectively.

    Measure Section: Numerator

    Source of Change: Measure Lead

  • Updated frequency of BMI documented from <=6 month to <=12 months to align with guidelines.

    Measure Section: Numerator

    Source of Change: Expert Work Group Review

  • Replaced the 'starts before start of' and 'starts before end of' logical operator for situations in which time stamps are not attached to procedures, diagnosis, and immunizations. Wherever applicable, the operators have been changed to 'starts before or concurrent with start of' or 'starts before or concurrent with end of' respectively.

    Measure Section: Denominator Exceptions

    Source of Change: Measure Lead

  • Updated frequency of BMI documented from <=6 month to <=12 months to align with guidelines.

    Measure Section: Denominator Exceptions

    Source of Change: Expert Work Group Review

Value Set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Below Normal Medications (2.16.840.1.113883.3.600.1.1499): Added 3 RXNORM codes (197634, 197635, 197636).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Palliative Care (2.16.840.1.113883.3.600.1.1579): Deleted 1 ICD9CM code (V66.7). Deleted 1 ICD10CM code (Z51.5). Added 1 SNOMEDCT code (103735009).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set BMI Encounter Code Set (2.16.840.1.113883.3.600.1.1751): Deleted 1 CPT code (98960).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Overweight (2.16.840.1.113883.3.600.2387): Added 9 SNOMEDCT codes (162690006, 162863004, 162864005, 238136002, 275947003, 408512008, 414915002, 415530009, 83911000119104).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Underweight (2.16.840.1.113883.3.600.2388): Added 1 SNOMEDCT code (162769006).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Pregnancy Dx (2.16.840.1.113883.3.600.1.1623): Deleted 1109 ICD9CM codes. Added 19 ICD10CM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Above Normal Follow-up (2.16.840.1.113883.3.600.1.1525): Added 4 HCPCS codes (G0270, G0271, G0447, G0473) and deleted 1 HCPCS code (G8417). Deleted 2 ICD9CM codes (V65.3, V65.41). Added 7 CPT codes (43659, 43886, 43888, 97802, 97803, 99401, 99402).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Below Normal Follow up (2.16.840.1.113883.3.600.1.1528): Deleted 1 ICD9CM code (V65.3).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Above Normal Medications (2.16.840.1.113883.3.600.1.1498): Added 17 RXNORM codes.

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set BMI Encounter Code Set (2.16.840.1.113883.3.600.1.1751): Added 6 CPT codes (97165, 97161, 97162, 97163, 97166, 97167) and deleted 2 CPT codes (97001, 97003).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Pregnancy Dx (2.16.840.1.113883.3.600.1.1623): Added 28 ICD10CM codes and deleted 5 ICD10CM codes (O00.10, O00.11, O00.20, O00.21, Z36).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

  • Value set Above Normal Follow-up (2.16.840.1.113883.3.600.1.1525): Added 1 ICD10CM code (Z71.82).

    Measure Section: QDM Data Elements

    Source of Change: 2018 Addendum

External Resources