NQF 0421: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up

Measure:

Record the percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter.

Normal Parameters: 
• Age 65 years and older BMI => 23 and < 30 kg/m2 
• Age 18 - 64 years BMI => 18.5 and < 25 kg/m2

 Numerator:

Patients with a documented BMI during the 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 current encounter.

Denominator 1:

All patients 18 through 64 years on the date of the encounter with at least one eligible encounter during the measurement period NOT INCLUDING encounters where the patient is receiving palliative care, refuses measurement of height and/or weight, the 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, or there is any other reason documented in the medical record by the provider explaining why BMI measurement was not appropriate.

Denominator 2:

All patients 65 years of age and older on the date of the encounter with at least one eligible encounter during the measurement period NOT INCLUDING encounters where the patient is receiving palliative care, refuses measurement of height and/or weight, the 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, or there is any other reason documented in the medical record by the provider explaining why BMI measurement was not appropriate.

Denominator
Exclusion 1:

Patients who are pregnant or encounters where the patient is receiving palliative care, refuses measurement of height and/or weight, the 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, or there is any other reason documented in the medical record by the provider explaining why BMI measurement was not appropriate.

Denominator
Exclusion 2:

Encounters where the patient is receiving palliative care, refuses measurement of height and/or weight, the 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, or there is any other reason documented in the medical record by the provider explaining why BMI measurement was not appropriate.

NQS Domain:

Population/Public Health

In ChartMaker Clinical:

In order to qualify for this measure, the provider must have seen the patient, age 18 and older, at least one time during the reporting period and have the appropriate information documented in the chart:

Required Data Elements for the Denominators*: 

• BMI Encounter Code
CPT:  
CodeDescription
90791Psychiatric diagnostic evaluation
90792Psychiatric diagnostic evaluation with medical services
90832Psychotherapy, 30 minutes with patient and/or family member
90834Psychotherapy, 45 minutes with patient and/or family member
90837Psychotherapy, 60 minutes with patient and/or family member
90839Psychotherapy for crisis; first 60 minutes
96150Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment
96151Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; re-assessment
96152Health and behavior intervention, each 15 minutes, face-to-face; individual
97001Physical therapy evaluation
97003Occupational therapy evaluation
97802Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes
97803Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
98960Education 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
99201Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
99202Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 20 minutes are spent face-to-face with the patient and/or family.
99203Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Typically, 30 minutes are spent face-to-face with the patient and/or family.
99204Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 45 minutes are spent face-to-face with the patient and/or family.
99205Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99212Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Typically, 10 minutes are spent face-to-face with the patient and/or family.
99213Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99214Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99215Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99385Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years
99386Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years
99387Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older
99395Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 18-39 years
99396Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years
99397Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older
G0101Cervical or vaginal cancer screening; pelvic and clinical breast examination
G0108Diabetes outpatient self-management training services, individual, per 30 minutes
G0270Medical 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
G0271Medical 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
G0402Initial preventive physical examination; face-to-face visit, services limited to new beneficiary during the first 12 months of medicare enrollment
G0438Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
G0439Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
G0447Face-to-face behavioral counseling for obesity, 15 minutes
SNOMED:  
CodeDescription
185349003Encounter for "check-up" (procedure)
30346009Evaluation and management of established outpatient in office or other outpatient facility (procedure)
37894004Evaluation and management of new outpatient in office or other outpatient facility (procedure)
108221006Evaluation AND/OR management - established patient (procedure)
108220007Evaluation AND/OR management - new patient (procedure)
46662001Examination of breast (procedure)
390906007Follow-up encounter (procedure)
83607001Gynecologic examination (procedure)
14736009History and physical examination with evaluation and management of patient (procedure)
78318003History and physical examination, annual for health maintenance (procedure)
18512000Individual psychotherapy (regime/therapy)
90526000Initial evaluation and management of healthy individual (procedure)
165171009Initial psychiatric evaluation (procedure)
8411005Interactive individual medical psychotherapy (regime/therapy)
13607009Manual examination of breast (procedure)
35025007Manual pelvic examination (procedure)
410170008Nutrition care assessment (procedure)
410172000Nutrition care management (procedure)
386372009Nutrition management (regime/therapy)
410155007Occupational therapy assessment (procedure)
410157004Occupational therapy management (procedure)
308335008Patient encounter procedure (procedure)
270427003Patient-initiated encounter (procedure)
86013001Periodic reevaluation and management of healthy individual (procedure)
410158009Physical therapy assessment (procedure)
410160006Physical therapy management (procedure)
108224003Preventive patient evaluation (procedure)
270430005Provider-initiated encounter (procedure)
32537008Psychiatric diagnostic interview, examination, history, mental status and disposition (procedure)
10197000Psychiatric interview and evaluation (procedure)
108311000Psychiatric procedure, interview AND/OR consultation (procedure)
225967005Self-care patient education (procedure)
68381003Surgical removal of erupted tooth requiring elevation of mucoperiosteal flap and removal of bone and/or section of tooth (procedure)
55162003Tooth extraction (procedure)
406547006Urgent follow-up (procedure)
185463005Visit out of hours (procedure)
185465003Weekend visit (procedure)

If one of the following is documented, the patient will not be included in the denominators:

• Palliative Care Diagnosis Exclusion Code (with attached SNOMED)
ICD-9:  
CodeDescription
V66.7Encounter for palliative care
ICD-10: 
CodeDescription
Z51.5Encounter for palliative care
SNOMED:  
CodeDescription
305284002Admission by palliative care physician (procedure)
305381007Admission to palliative care department (procedure)
133918004Comfort measures (regime/therapy)
385736008Dying care (regime/therapy)
385763009Hospice care (regime/therapy)
305981001Referral by palliative care physician (procedure)
306288008Referral to palliative care physician (procedure)
306237005Referral to palliative care service (procedure)
182964004Terminal care (regime/therapy)
• Patient Refusal (SNOMED) Code
SNOMED:  
CodeDescription
105480006Refusal of treatment by patient (situation)
183944003Procedure refused (situation)
183945002Procedure refused for religious reason (situation)
413310006Patient non-compliant - refused access to services (situation)
413311005Patient non-compliant - refused intervention / support (situation)
413312003Patient non-compliant - refused service (situation)
• Medical and Other Reason Exclusion (SNOMED) Code
SNOMED:  
CodeDescription
183932001Procedure contraindicated (situation)
397745006Medical contraindication (finding)
407563006Treatment not tolerated (situation)
428119001Procedure not indicated (situation)

Required Data Elements for the Numerator*: 

• Documented BMI Results at the current visit or within the last 6 months

• Documented in the vitals button in a note:

vitals

If the BMI is outside of the normal parameters, the following must be documented:

• Under (Below Normal BMI) or Overweight (Above Normal BMI) (SNOMED) finding
SNOMED:  
CodeDescription
248342006Underweight (finding)
238131007Overweight (finding)

     As well as one of the following:

• Follow-Up Intervention Code (by Above or Below Normal BMI designation)

Follow-Up Codes for Above Normal BMI:  

CPT/HCPCS: 
CodeDescription
43644Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and Roux-en-Y gastroenterostomy (roux limb 150 cm or less)
43645Laparoscopy, surgical, gastric restrictive procedure; with gastric bypass and small intestine reconstruction to limit absorption
43770Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (eg, gastric band and subcutaneous port components)
43771Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only
43772Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only
43773Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only
43774Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components
43842Gastric restrictive procedure, without gastric bypass, for morbid obesity; vertical-banded gastroplasty
43843Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than vertical-banded gastroplasty
43845Gastric restrictive procedure with partial gastrectomy, pylorus-preserving duodenoileostomy and ileoileostomy (50 to 100 cm common channel) to limit absorption (biliopancreatic diversion with duodenal switch)
43846Gastric restrictive procedure, with gastric bypass for morbid obesity; with short limb (150 cm or less) Roux-en-Y gastroenterostomy
43847Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorption
43848Revision, open, of gastric restrictive procedure for morbid obesity, other than adjustable gastric restrictive device (separate procedure)
97804Medical nutrition therapy; group (2 or more individual(s)), each 30 minutes
98960Education 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
99078Physician 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)
G8417Bmi is documented above normal parameters and a follow-up plan is documented
S9449Weight management classes, non-physician provider, per session
S9451Exercise classes, non-physician provider, per session
S9452Nutrition classes, non-physician provider, per session
S9470Nutritional counseling, dietitian visit
  
SNOMED:  
CodeDescription
424753004Dietary management education, guidance, and counseling (procedure)
370847001Dietary needs education (procedure)
386291006Exercise promotion: strength training (procedure)
386292004Exercise promotion: stretching (procedure)
418995006Feeding regime (regime/therapy)
304549008Giving encouragement to exercise (procedure)
443288003Lifestyle education regarding diet (procedure)
413315001Nutrition / feeding management (regime/therapy)
386373004Nutrition therapy (regime/therapy)
386463000Prescribed activity/exercise education (procedure)
386464006Prescribed diet education (procedure)
361231003Prescribed dietary intake (regime/therapy)
410177006Special diet education (procedure)
307818003Weight monitoring (regime/therapy)

Follow-Up Codes for Below Normal BMI:

CPT/HCPCS: 
CodeDescription
G8418Bmi is documented below normal parameters and a follow-up plan is documented
S9449Weight management classes, non-physician provider, per session
S9452Nutrition classes, non-physician provider, per session
S9470Nutritional counseling, dietitian visit
  
SNOMED:  
CodeDescription
429095004Dietary education for weight gain (procedure)
424753004Dietary management education, guidance, and counseling (procedure)
418995006Feeding regime (regime/therapy)
443288003Lifestyle education regarding diet (procedure)
413315001Nutrition / feeding management (regime/therapy)
386464006Prescribed diet education (procedure)
410177006Special diet education (procedure)
• Referral Intervention (SNOMED) Code (by Above or Below Normal BMI designation)
SNOMED:  
CodeDescription
103698003Patient referral to non-physician provider (procedure)
103699006Patient referral to dietitian (procedure)
183515008Referral to physician (procedure)
183524004Referral to psychiatry service (procedure)
183583007Refer to mental health worker (procedure)
185359002Referred by another general practitioner (finding)
305922005Referral by mental health counselor (procedure)
306136006Referral to liaison psychiatry service (procedure)
306163007Referral to dietetics service (procedure)
306164001Referral to community-based dietetics service (procedure)
306165000Referral to hospital-based dietetics service (procedure)
306166004Referral to occupational therapy service (procedure)
306167008Referral to community-based occupational therapy service (procedure)
306168003Referral to hospital-based occupational therapy service (procedure)
306226009Referral to mental health counseling service (procedure)
306227000Referral for mental health counseling (procedure)
306252003Referral to mental health counselor (procedure)
306344004Referral to professional allied to medicine (procedure)
306353006Referral to community-based dietitian (procedure)
306354000Referral to hospital-based dietitian (procedure)
308459004Referral to psychologist (procedure)
308470006Referral to general physician (procedure)
308477009Referral to psychiatrist (procedure)
390864007Referral for exercise therapy (procedure)
390866009Referral to mental health team (procedure)
390893007Referral to physical activity program (procedure)
408289007Refer to weight management program (procedure)
410160006Physical therapy management (procedure)
416790000Referral for home physical therapy (procedure)
424203006Physical therapy education, guidance and counseling (procedure)
91251008Physical therapy procedure (regime/therapy)
• Medications (by Above or Below Normal BMI designation)

Medications for Above Normal BMI:

  • orlistat 120 MG Oral Capsule
  • orlistat 60 MG Oral Capsule

Medications for Below Normal BMI:

  • Megestrol Acetate 125 MG/ML Oral Suspension
  • Megestrol Acetate 160 MG Oral Tablet
  • Megestrol Acetate 20 MG Oral Tablet
  • Megestrol Acetate 40 MG Oral Tablet
  • Megestrol Acetate 40 MG/ML Oral Suspension

EXCLUSION DETAILS: 

This measure makes an exclusion for qualifying patients in each denominator.  For Denominator 1 (ages 18-64) , patients are excluded who are pregnant, undergoing palliative care, those who refuse to have height and/or weight documented or for a documented reason as to why the BMI was not recorded (such as patients in an emergency situation).  For Denominator 2 (ages 65 and older), the patients are excluded who are undergoing palliative care, those who refuse to have height and/or weight documented or for a documented reason as to why the BMI was not recorded (such as patients in an emergency situation).  In order to meet the requirements for this exception, the appropriate information must be documented in the chart:

• Pregnancy Diagnosis Exclusion Codes (with attached SNOMED)

*ADDITIONAL INFORMATION:

•  The only data used to determine the denominator is data from the ChartMaker Clinical Module. If a patient encounter was not entered into the ChartMaker Clinical Module, that encounter is not included in the denominator for the statistical calculations on the Meaningful Use Dashboard. Please add these additional patients to the denominator and recalculate the percentage for Attestation purposes.

•  The SNOMED codes required for Overweight, Underweight, MUST be attached to either:
     - the procedure code indicating Follow-Up Intervention
     - the same procedure code where the SNOMED for Follow-up or Referral Intervention are attached.  (Note:  the BMI office encounter code can not be used)
     - a procedure, other than the office encounter code, when prescribing the medication intervention
     
•  When using a SNOMED code for Patient, Medical or Other reason not performed:
     - it MUST be attached to the same procedure as the Under/Overweight SNOMED code
     - the procedure code must also be marked as "Procedure Not Performed"
     - the procedure code can not be the BMI office encounter code

•  When using a SNOMED code for Follow-Up Intervention or Referral, it must be attached to the same procedure code as the Under/Overweight SNOMED code  (Note:  the BMI office encounter code can not be used)

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