Adult Weight Screening and Follow-Up
Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow-up plan is documented.
DESCRIPTION: Percentage of patients aged 18 years and older with a documented BMI during the current encounter or during the previous six months AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the encounter.
Normal Parameters: Age 65 years and older BMI ≥ 23 and < 30
Age 18-64 years BMI ≥ 18.5 and < 25
INSTRUCTIONS: This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period. The most recent quality code submitted will be used for performance calculation. There is no diagnosis associated with this measure. 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 measurespecific denominator coding. The BMI documented in the medical record may be reported if done in the provider’s office/facility or if a BMI is documented within the previous six months in outside medical records obtained by the provider. If the most recent documented BMI is outside of normal parameters, then a follow-up plan must be documented within six months of the abnormal BMI. The documented follow-up interventions must be related to the BMI outside of normal parameters, example: “Patient referred to nutrition counseling for BMI above normal parameters”. Measure Reporting via Claims: CPT codes or HCPCS codes, and patient demographics are used to identify patients who are included in the measure’s denominator. Quality-data codes are used to report the numerator of the measure. When reporting the measure via claims, submit the listed CPT or HCPCS codes, and the appropriate numerator quality-data code. All measure-specific coding should be reported on the claim(s) representing the eligible encounter. Measure Reporting via Registry: CPT codes or HCPCS codes, and patient demographics are used to identify patients who are included in the measure’s denominator. The listed numerator options are used to report the numerator of the measure. The quality-data codes listed do not need to be submitted for registry-based submissions; however, these codes may be submitted for those registries that utilize claims data.
DENOMINATOR: All patients aged 18 years and older Denominator Criteria (Eligible Cases): Patients aged >18 years on date of encounter AND Patient encounter during the reporting period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 90839, 96150, 96151, 96152, 97001, 97003, 97802, 97803, 98960, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, D7140, D7210, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447
NUMERATOR: Patients with a documented BMI during the encounter or during the previous six months, AND when the BMI is outside of normal parameters, follow-up is documented during the encounter or during the previous six months of the encounter with the BMI outside of normal parameters Numerator Instructions: An eligible professional or their staff is required to measure both height and weight. Both the height and the weight must be measured within the same six months. Self-reported values cannot be used. The documentation of a follow-up plan must be based on the most recent documented BMI within the previous six months Definitions: BMI – Body mass index (BMI), is a number calculated using the Quetelet index: weight divided by height squared (W/H2) and is commonly used to classify weight categories. BMI can be calculated using: Metric Units: BMI = Weight (kg) / (Height (m) x Height (m)) OR English Units: BMI = Weight (lb) / (Height (in) x Height (in)) x 703 Follow-Up Plan – Proposed outline of treatment to be conducted as a result of a BMI out of normal parameters. A follow-up may include but is not limited to: documentation education, a referral (e.g., a registered dietician, nutritionist, occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professional, or surgeon), pharmacological interventions, dietary supplements, exercise counseling, or nutrition counseling. Not Eligible for BMI Calculation or Follow-Up Plan – A patient is not eligible if one or more of the following reasons are documented: x Patient is receiving palliative care x Patient is pregnant x Patient refuses BMI measurement (refuses height and/or weight) x Any other reason documented in the medical record by the provider why BMI calculation or follow-up plan was not appropriate x Patient is in an urgent or emergent medical situation where time is of the essence, and to delay treatment would jeopardize the patient’s health status
Numerator Quality-Data Coding Options for Reporting Satisfactorily: BMI Documentedas Normal, No Follow-Up Plan Required (One quality-data code [G8417, G8418 or G8420] is required on the claim form to submit this numerator option) G8420: BMI is documented within normal parameters and no follow-up plan is required OR BMI Documented as Above Normal Parameters, AND Follow-Up Documented G8417: BMI is documented above normal parameters and a follow-up plan is documented OR BMI Documented as Below Normal Parameters, AND Follow-Up Documented G8418: BMI is documented below normal parameters and a follow-up plan is documented
BMI not Documented, Patient not Eligible (One quality-data code [G8422 or G8938] is required on the claim form to submit this numerator option) G8422: BMI not documented, documentation the patient is not eligible for BMI calculation OR BMI Documented Outside of Normal Limits, Follow-up Plan not Documented, Patient not Eligible G8938: BMI is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible OR BMI not Documented, Reason not Given (One quality-data code [G8419 or G8421] is required on the claim form to submit this numerator option) G8421: BMI not documented and no reason is given
BMI Documented Outside of Normal Parameters, Follow-Up Plan not Documented, Reason not Given G8419: BMI documented outside normal parameters, no follow-up plan