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

Last updated: September 14, 2018

CMS Measure ID: CMS69v7
Version: 7
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 Populationinfo-icon

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

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
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 professionalsinfo-icon 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 denominatorinfo-icon coding.

BMI Measurement Guidance:

* Height and Weight - An eligible professionalinfo-icon 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 and exceptions criteria to determine those patients that BMI measurement may not be appropriate or necessary.

Follow-Up Plan Guidance:

* 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

Quality ID: 128
Meaningful Measure: Preventive Care

Specifications

Release Notes

Header

  • Updated Version Number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated Disclaimer.

    Measure Section: Disclaimer

    Source of Change: Measure Lead

  • Updated Rationale and References based on review of more recent literature.

    Measure Section: Rationale

    Source of Change: Measure Lead

  • Updated Clinical Recommendation Statement based on most recent guidelines added to references.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Measure Lead

  • Updated Rationale and References based on review of more recent literature.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Revised RDN title based on expert workgroup recommendation and added language to align with revisions made to clinical recommendation statement.

    Measure Section: Definition

    Source of Change: Expert Work Group Review

  • Updated to reflect addition of logic that allows for the use of medical reason exception for not obtaining a BMI result.

    Measure Section: Guidance

    Source of Change: JIRAinfo-icon (CQMinfo-icon-2640)

  • Updated to reflect addition of logic that allows for the use of medical reason exception for not obtaining a BMI result.

    Measure Section: Denominator Exceptionsinfo-icon

    Source of Change: JIRA (CQM-2640)

Logic

  • Added medical reason exception for not obtaining a BMI result.

    Measure Section: Denominator Exceptions

    Source of Change: JIRA (CQM-2640)

  • Added supplemental timing attributes to most datatypes in QDMinfo-icon 5.3 to facilitate accurate retrieval of time related information within CQLinfo-icon logic. Timing attributes now include a time interval, such as prevalence period or relevant period, and/or actual time of documentation with Author Datetime. Relevant period is the general method to describe start and stop times for datatypes. Prevalence period is used for some datatypes to more accurately define onset and abatement times.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Assigned cardinality to each attribute to be more explicit in guiding specificationinfo-icon and implementation of QDM data elements. Cardinality refers to the number of instances of the attribute that can be included in the measure description. Cardinality for most attributes is 0.. 1 (i.e., can occur up to 1 time), but some attributes have a cardinality of 0.. * (i.e., can occur multiple times).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • CQL libraries contain sets of CQL definitions, or CQL expression statements. A context statement, patient or population, can now be used in a CQL library to clearly establish how the subsequent list of CQL expressions will be interpreted. A 'Population' context will interpret the CQL expression with reference to the entire population of the item being counted, patients or encounters. A 'Patient' context will interpret the CQL expression with reference to a single patient. Context statements are not required, but one or more context statements may be used within a library to help clarify how the CQL expressions will be interpreted. Patient context is the default if none is specified.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Replaced measure-defined definitions with similar definitions and functions from CQL shared libraries for consistency across measures.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated measure logic from Quality Data Model (QDM)-based logic to Clinical Quality Language (CQL)-based logic. Information on CQL can be found at the eCQI Resource centerinfo-icon (https://ecqi.healthit.gov/cql). Information about specific versions of the new standards in use for CMS reporting periods can be found at the eCQI Resource Center (https://ecqi.healthit.gov/ecqm-tools-key-resources). Switching from QDM to CQL brings with it many changes, as well as enhanced expression capability, but only those changes with significant impact will be outlined in technical release notes. For example, in the case of timing operators, changes may only be summarized if those changes impact the measure calculation.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Setinfo-icon

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • Value set BMI Encounter Code Set (2.16.840.1.113883.3.600.1.1751): Added 24 CPT codes. Added 1 HCPCS code (G0473).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 11 SOP codes (299, 32127, 32128, 391, 517, 524, 614, 621, 622, 623, 629) and deleted 3 SOP codes (63, 64, 69).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Replaced 'Overweight' (2.16.840.1.113883.3.600.2387) value set with new 'Overweight or Obese' grouping value set (2.16.840.1.113762.1.4.1047.502) that incorporates the 'Overweight' value set and includes seven additional ICD10CM codes. Change better aligns with measure intent.

    Measure Section: QDM Data Elements

    Source of Change: JIRA (CQM-2793)

  • Replaced LOINC single code value sets with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: QDM Data Elements

    Source of Change: Standards Update

  • Value set Pregnancy Dx (2.16.840.1.113883.3.600.1.1623): Added 6 ICD10CM codes (O86.00, O86.01, O86.02, O86.03, O86.04, O86.09) and deleted 1 ICD10CM code (O86.0).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

  • Value set Payer (2.16.840.1.114222.4.11.3591): Deleted 1 SOP code (24).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

External Resources