CMS 69v6: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

Measure: 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

Measure TypeHigh Priority MeasureScoring
ProcessNoA higher percentage indicates better quality
DenominatorAll patients 18 and older on the date of the encounter with at least one eligible encounter during the measurement period
NumeratorPatients 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
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

Denominator Exclusions
  • Patients who are pregnant
  • Patients receiving palliative care
  • Patients who refuse measurement of height and/or weight or refuse follow-up

Patients who meet the following criteria will be included in the denominator:

  • Age must be ≥ 18 years at the beginning of the Measurement Period

    AND

  • Have at least one encounter during the Measurement Period finalized by the EC/EP

CPT: 90791, 90792, 90832, 90834, 90837, 96150, 96151, 96152, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99385, 99386, 99387, 99395, 99396, 99397

HCPCS: G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447

A patient will be counted as an exception if there is a medical reason for not documenting their BMI or providing a BMI follow-up plan if BMI was out of normal range. The reason for exception must be documented on the day of the encounter or in the 12 months prior.

  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
  2. From the BMI – Adult flowsheet, click Add Column
  3. Select Emergent Situation from the Patient is an exclusion or exception due to the following reason list
  4. Click OK to save

A patient will be excluded from this measure if they meet any of the following conditions:

  • Are receiving palliative care during the Measurement Period
  • Have an active diagnosis of pregnancy during the Measurement Period
  • Refuse to have their BMI documented or refuse a follow-up plan if BMI is out of normal range

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible pregnancy diagnosis codes can be located here.

  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
  2. From the BMI – Adult flowsheet, click Add Column
  3. Select Has a terminal illness, Refuses BMI, or Pregnant from the Patient is an exclusion or exception due to the following reason list
  4. Click OK to save

A patient will be counted in the numerator if their BMI was documented during the encounter or in the 12 months prior. If the patient’s BMI is outside of the normal range (as defined by this measure), a BMI Management plan must be provided to be counted in the numerator.

If more than one BMI is documented during the Measurement Period, the most recent BMI will be used to determine if the measure performance has been met

BMI is calculated based on the patient height and weight as entered in the Vitals tab of an encounter.

To document height and weight, go to Encounter > Vitals and click Add/Retake Vitals

For patients whose BMI falls outside of the normal range, a follow-up plan for BMI management must be provided. BMI management can be documented in the BMI – Adult flowsheet, as a diagnosis, as a procedure, or through the prescription of a medication.

  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
  2. From the BMI – Adult flowsheet, click Add Column
  3. Select the Done checkbox for BMI Management Plan
  4. Click OK to save

Diagnoses are documented in the Assessment tab of an encounter. A comprehensive list of eligible diagnosis codes for BMI management can be located here.

To prescribe a medication, go to Encounter > Medications > Manage/Prescribe Meds > Prescribe a Medication. A comprehensive list of eligible BMI management medications can be located here.

To document a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add an eligible code. Order Status must be marked as Complete in order to count toward the numerator. A comprehensive list of eligible procedure codes for BMI management can be located here.

https://ecqi.healthit.gov/ecqm/ep/2018/cms069v6

 

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