CMS 69v9: 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 within the previous twelve months AND who had a follow-up plan documented if most recent BMI was outside of normal parameters

Measure Type High Priority Measure Scoring
Process No A higher percentage indicates better quality
Denominator All patients 18 and older on the date of the encounter with at least one eligible encounter during the measurement period
Numerator 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
Denominator Exceptions
  • Patients with a documented medical reason for not documenting BMI or for not documenting a follow-up plan for a BMI outside normal parameters, such as elderly patients (65 or older) for whom weight reduction/weight gain would complicate other underlying health conditions such as illness or physical disability, mental illness, dementia, confusion, or nutritional deficiency such as vitamin/mineral deficiency or 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
  • Patients who refuse measurement of height and/or weight
Denominator Exclusions
  • Patients who are pregnant
  • Patients receiving palliative or hospice care

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

  • Age is ≥ 18 years at the beginning of the Measurement Period

    AND

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

CPT: 90791, 90792, 90832, 90834, 90837, 96156, 96158, 96159, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99236, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99339, 99340, 99385, 99386, 99387, 99395, 99396, 99397, 99401, 99402

HCPCS: G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447, G0473

A patient will be counted as an exception if there is a medical reason or urgent medical situation for not documenting their BMI or for not providing a BMI follow up plan if BMI was out of the normal range. A patient who refuses to have their height or weight measured will also be counted as an exception.

The reason for the exception must be documented on the day of the eligible encounter.

  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
  2. From the BMI – Adult flowsheet, click Add Column
  3. Select Emergent situation, Has a terminal illness, Medical reason, or Physical disability from the No BMI obtained due to list
  4. Click OK to save

  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
  2. From the BMI – Adult flowsheet, click Add Column
  3. Select a Value from the BMI Management Plan not done due to list
  4. Click OK to save

  1. Go to Encounter > Flowsheets/Labs > Standard Flowsheets
  2. From the BMI – Adult flowsheet, click Add Column
  3. Select Patient Refused from the No BMI obtained due to list
  4. Click OK to save

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

  • Has an active diagnosis of pregnancy during the Measurement Period
  • Has an order for hospice care on or before the eligible encounter date
  • Is receiving palliative care during the Measurement Period

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

To document hospice care services as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

SNOMED CT: 385763009, 385765002

Order Status must be marked as Pending or Complete.

SNOMED CT codes must be added as a Favorite in Preferences > Form Data > Orders to be accessible from the Orders/Referrals tab.

A patient will be counted as an exclusion if the following diagnosis was Added or Assessed on or before the eligible encounter date:

ICD-10: Z51.5

The encounter must be finalized by the EC/EP and must be one of the following encounter types: Multi-System, Exam, Procedure, Initial OB Visit, OB Follow Up Visit, Postpartum Visit, or Urgent Care.

A patient will be counted in the numerator if their BMI was documented during the eligible 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 follow up plan must be provided for the patient to be counted in the numerator.

This measure defines Normal BMI Parameters as: Age 18 years and older BMI ≥ 18.5 and < 25 kg/m2

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

The BMI follow up plan can be documented in any of the following ways:

  • As a referral in the BMI – Adult flowsheet

  • As an active or resolved diagnosis

  • As a procedure

  • As a prescription for medication

The BMI follow up plan must be provided on the day of the eligible 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 a Value from the BMI Referral to list
  4. Click OK to save

This action does not create a referral in Sevocity. Referrals are created from the Referrals tab in the chart or from the Orders/Referrals tab in an encounter

Diagnoses are documented in the Assessment tab of an encounter. The eligible diagnosis codes for BMI follow up plan are:

Above Normal BMI Follow Up

ICD-10: Z71.3, Z71.82

Below Normal BMI Follow Up

ICD-10: Z71.3

To document a BMI follow up plan as a procedure, go to Encounter > Orders/Procedure > Orders/Referrals and click Add to add one of the eligible codes listed below:

Above Normal BMI Follow Up

CPT: 43644, 43645, 43659, 43770, 43771, 43772, 43773, 43774, 43842, 43843, 43845, 43846, 43847, 43848, 43886, 43888, 97802, 97803, 97804, 98960, 99078, 99401, 99402

HCPCS: G0270, G0271, G0447, G0473, S9449, S9451, S9452, S9470

Below Normal BMI Follow Up

CPT: 97802, 97803, 97804, 98960, 99078, 99401, 99402

HCPCS: G0270, G0271, S9449, S9452, S9470

Order Status must be marked as Pending or Complete.

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

https://ecqi.healthit.gov/ecqm/ep/2021/cms069v9

 

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