(2024) Electronic Clinical Quality Measures
Description:
Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the measurement period AND who had a follow-up plan documented if BMI was outside of normal parameter.
Guidance:
BMI Measurement Guidance:
- Height and Weight - An eligible professional or their staff is required to measure both height and weight. Both height and weight must be measured during the measurement period. 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 documented BMI is outside of normal parameters, then a follow-up plan is documented during the encounter or during the measurement period.
- If more than one BMI is reported during the measurement period, and any of the documented BMI assessments is outside of normal parameters, documentation of an appropriate follow-up plan will be used to determine if 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 documented BMI, outside of normal parameters, example: "Patient referred to nutrition counseling for BMI above or below normal parameters." See the Definition section 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. and Holme and Tonstad 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. See the Denominator Exception section for examples.
This eCQM is a patient-based measure. This measure is to be reported a minimum of once per measurement period for patients seen during the measurement period.
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 encounter and the measure-specific denominator coding.
Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.
This version of the eCQM uses QDM version 5.6. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM
Initial Population:
All patients aged 18 and older on the date of the encounter with at least one qualifying encounter during the measurement period.
Date of birth information can be entered in DrChrono in the patient chart under the Demographics tab with the Patient's Date of Birth.
With an encounter during the measurement period where BMI could be assessed
CPT Codes:
90791, 90792, 90832, 90834, 90837, 96156, 96158, 96159, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 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 Codes:
D3921, D7111, D7140, D7210, D7220, D7230, D7240,D7241, D7250, D7251, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447, G0473
CPT and HCPCS codes can be entered into the billing section for the encounter. Below is an example from the appointment window.
Denominator:
Equals initial population.
Denominator Exclusions:
Patients who are pregnant at any time during the measurement period.
Patients receive palliative or hospice care at any time during the measurement period.
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 (e.g., elderly patients 65 years of age 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; 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.
Numerator:
Patients with a documented BMI during the encounter or the measurement period, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or the measurement period.
BMI can be documented in the Vitals section for the patient's encounter.
This will be saved in the patient's chart under the Physical Exam area in the CQMs section with the LOINC code 39156-5.
Follow-up for high or low BMI can be documented in different areas depending on the code type.
ICD-10
ICD-10 codes can be added to the billing or assessment section of a patient's appointment or in the patient's chart under the Problem List.
| Z71.3 | Dietary counseling and surveillance |
| Z71.82 | Exercise counseling |
CPT Codes and HCPCS
CPT and HCPCS Codes for the follow-up can be entered in the billing section for the encounter.
HCPCS codes
| G0270 | Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face with the patient, each 15 minutes |
| G0271 | Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individuals), each 30 minutes |
| G0447 | Face-to-face behavioral counseling for obesity, 15 minutes |
| G0473 | Face-to-face behavioral counseling for obesity, group (2-10), 30 minutes |
| S9449 | Weight management classes, non-physician provider, per session |
| S9451 | Exercise classes, non-physician provider, per session |
| S9452 | Nutrition classes, non-physician provider, per session |
| S9470 | Nutritional counseling, dietitian visit |
CPT Codes
| 43644 | Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less) |
| 43645 | Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption |
| 43659 | Unlisted laparoscopy procedure, stomach |
| 43770 | Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components) |
| 43771 | Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only |
| 43772 | Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only |
| 43773 | Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only |
| 43774 | Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components |
| 43842 | Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty |
| 43843 | Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty |
| 43845 | Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch) |
| 43846 | Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy |
| 43847 | Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption |
| 43848 | Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure) |
| 43886 | Gastric restrictive procedure, open; revision of subcutaneous port component only |
| 43888 | Gastric restrictive procedure, open; removal and replacement of subcutaneous port component only |
| 97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
| 97803 | Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
| 97804 | Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes |
| 98960 | Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient |
| 99078 | Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions) |
| 99401 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes |
| 99402 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes |
| 97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
| 97803 | Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
| 97804 | Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes |
| 98960 | Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient |
| 99078 | Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions) |
| 99401 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes |
| 99402 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes |
| 97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
| 97803 | Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes |
| 97804 | Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes |
| 98960 | Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient |
| 99078 | Physician or other qualified health care professional qualified by education, training, licensure/regulation (when applicable) educational services rendered to patients in a group setting (eg, prenatal, obesity, or diabetic instructions) |
| 99401 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes |
| 99402 | Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes |
SNOMEDCT Codes
SNOMED CT codes can be entered in the patient's chart under the Intervention area of the CQMs section. Click the +New button.
You can enter the code or search by keyword. Select an appointment, performed or ordered, and then click Create.
| 182922004 | Dietary regime (regime/therapy) |
| 304549008 | Giving encouragement to exercise (procedure) |
| 307818003 | Weight monitoring (regime/therapy) |
| 370847001 | Dietary needs education (procedure) |
| 386291006 | Exercise promotion: strength training (procedure) |
| 386292004 | Exercise promotion: stretching (procedure) |
| 386373004 | Nutrition therapy (regime/therapy) |
| 386463000 | Prescribed activity/exercise education (procedure) |
| 386464006 | Prescribed diet education (procedure) |
| 410177006 | Special diet education (procedure) |
| 413315001 | Nutrition / feeding management (regime/therapy) |
| 418995006 | Feeding regime (regime/therapy) |
| 424753004 | Dietary management education, guidance, and counseling (procedure) |
| 443288003 | Lifestyle education regarding diet (procedure) |
| 183515008 | Referral to physician (procedure) |
| 183524004 | Referral to psychiatry service (procedure) |
| 183583007 | Refer to mental health worker (procedure) |
| 306136006 | Referral to liaison psychiatry service (procedure) |
| 306163007 | Referral to dietetics service (procedure) |
| 306164001 | Referral to community-based dietetics service (procedure) |
| 306165000 | Referral to hospital-based dietetics service (procedure) |
| 306166004 | Referral to occupational therapy service (procedure) |
| 306167008 | Referral to community-based occupational therapy service (procedure) |
| 306168003 | Referral to hospital-based occupational therapy service (procedure) |
| 306226009 | Referral to mental health counseling service (procedure) |
| 306227000 | Referral for mental health counseling (procedure) |
| 306252003 | Referral to mental health counselor (procedure) |
| 306344004 | Referral to professional allied to medicine (procedure) |
| 306353006 | Referral to community-based dietitian (procedure) |
| 306354000 | Referral to hospital-based dietitian (procedure) |
| 308459004 | Referral to psychologist (procedure) |
| 308470006 | Referral to general physician (procedure) |
| 308477009 | Referral to psychiatrist (procedure) |
| 390864007 | Referral for exercise therapy (procedure) |
| 390866009 | Referral to mental health team (procedure) |
| 390893007 | Referral to physical activity program (procedure) |
| 408289007 | Refer to weight management program (procedure) |
| 416790000 | Referral for home physical therapy (procedure) |
Numerator Exclusions
Not applicable