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

Last updated: May 9, 2019

CMS Measure ID: CMS69v8
Version: 8
NQF Number: 421e
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 or hospice care

Patients who refuse measurement of height and/or weight

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:
Measure Scoring: Proportion
Measure Type: Process
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 & Tonstad [2015]; 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 eCQMinfo-icon version number.

    Measure Section: eCQM Version number

    Source of Change: Measure Lead

  • Added 'e' to NQFinfo-icon number.

    Measure Section: NQF Number

    Source of Change: Standards Update

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated rationale statement to align with recent literature.

    Measure Section: Rationale

    Source of Change: Expert Work Group Review

  • Updated clinical recommendation statement to align with updated clinical guideline.

    Measure Section: Clinical Recommendation Statement

    Source of Change: Expert Work Group Review

  • Updated references to align with American Psychological Association (APA) style.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated denominator exclusionsinfo-icon statement with removal of follow-up refusal wording to align with logic changes.

    Measure Section: Denominator Exclusions

    Source of Change: ONC Project Tracking System (JIRA)info-icon: CQMinfo-icon-3133

  • Updated denominator exclusions statement for 'Patients receiving palliative care' to 'Patients receiving palliative or hospice care' to align with the measure intent.

    Measure Section: Denominator Exclusions

    Source of Change: ONC Project Tracking System (JIRA): CQM-3023

  • Updated parenthetical citations to align with American Psychological Association (APA) style.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Updated the names of Clinical Quality Language (CQL)info-icon definitions, functions, and/or aliases for clarification and to align with CQL Style Guideinfo-icon.

    Measure Section: Definitions and Functions

    Source of Change: Standards Update

  • Added a 'union' operator of 'Intervention, Performed' for each 'Intervention, Order' for Above and Below Normal Follow-Up Interventions, and a 'union' operator of 'Intervention, Not Performed' for each 'Intervention, Not Ordered' for Above and Below Normal Follow-up Interventions not done due to a medical reason, to meet the measure intent.

    Measure Section: Multiple Sections

    Source of Change: ONC Project Tracking System (JIRA): CQM-2903

  • Updated Clinical Quality Language (CQL) expression to conform with the HL7info-icon Standard: Clinical Quality Language Specificationinfo-icon, Release 1 STUinfo-icon 3 (CQL 1.3).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated definitions and functions in the Measure Authoring Tool (MATinfo-icon) Global Common Functions Library to align with standards changes, Clinical Quality Language (CQL) Style Guide, and to include two new functions related to calculating hospital stays.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated version number of the Measure Authoring Tool (MAT) Global Common Functions Library (MATGlobalCommonFunctions-4.0.000).

    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): Deleted 2 SNOMED CT codes (30346009, 37894004). Added 7 CDT codes (D7111, D7220, D7230, D7240, D7241, D7250, D7251).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Below Normal Follow up (2.16.840.1.113883.3.600.1.1528): Added 7 HCPCS codes (97802, 97803, 97804, 98960, 99078, 99401, 99402) and deleted 1 HCPCS code (G8418).

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Above Normal Follow-Up (2.16.840.1.113883.3.600.1.1525): Added Gastric Procedures CPT extensional value set (2.16.840.1.113762.1.4.1047.515) including 16 codes. Deleted 16 CPT codes from Above Normal f/u CPT extensional value set (2.16.840.1.113883.3.600.1.1524).

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Changed the value set name from 'Palliative Care' to 'Palliative or Hospice Care' (2.16.840.1.113883.3.600.1.1579) to align with the measure intent.

    Measure Section: Terminology

    Source of Change: ONC Project Tracking System (JIRA): CQM-3023

  • Direct reference code for Birth date (LOINC Code (21112-8)) now displayed in Human Readable.

    Measure Section: Terminology

    Source of Change: Annual Update

  • ​Removed code systeminfo-icon versions from direct reference codes. Please refer to Appendix A of the Electronic Clinical Quality Measureinfo-icon Logic and Implementation Guidance document for a list of code system versions used in the eCQM specificationsinfo-icon for 2020 reporting/performance.

    Measure Section: Terminology

    Source of Change: Standards Update

  • Standardized purpose statement language in value sets across eCQMsinfo-icon. Value set purpose statements are visible in the Value Set Authority Center (VSAC) as well as the downloadable eCQM value set files.

    Measure Section: Terminology

    Source of Change: Measure Lead

External Resources