2017 MIPS Measure #128: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

Measure Description

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 18 years and older BMI => 18.5 and < 25 kg/m2

Instruction

There is no diagnosis associated with this measure. This measure is to be reported a minimum of once per performance period for patients seen during the performance period. This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided at the time of the qualifying visit and the measure-specific denominator coding. The BMI may be documented in the medicalrecord of the provider or 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 during the encounter or during the previoussix months of the current encounter. The documented follow-up plan must be based on the most recent documentBMI outside of normal parameters, example: “Patient referred to nutrition counseling for BMI above or below normal parameters” (See Definitions for examples of follow-up plan treatments). If more than one BMI is reported during the measure period, the most recent BMI will be used to determine if the performance has been met.

Denominator

All patients aged 18 years and older on the date of the encounter with at least one eligible encounter during the measurement period

Denominator Criteria (Eligible Cases):
Patients aged ≥18 years on date of encounter
AND
Patient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 96150, 96151, 96152, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 98960, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, D7140, D7210, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447
WITHOUT
Telehealth Modifier: GQ, GT
AND NOT
DENOMINATOR EXCLUSIONS:
BMI not documented, documentation the patient is not eligible for BMI calculation: G8422
OR
BMI is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible: G8938

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 sixmonths of the current encounter

Numerator Instructions:

• Height and Weight – An eligible professional or their staff is required to measure both height andweight. Both height and weight must be measured within six months of the current encounter and may be obtained from separate encounters. Self-reported values cannot be used.
• Follow-Up Plan – If the most recent documented BMI is outside of normal parameters, then a follow-up plan is documented during the encounter or during the previous six months of the current encounter.The documented follow-up plan must be based on the most recent documented BMI, outside of normal parameters, example: “Patient referred to nutrition counseling for BMI above or below normal parameters”. (See Definitions for examples of follow-up plan treatments).
• Performance Met for G8417 & G8418
  • If the provider documents a BMI and a follow-up plan at the current visit OR
  • If the patient has a documented BMI within the previous six months of the current encounter, the provider documents a follow-up plan at the current visit OR
  • If the patient has a documented BMI within the previous six months of the current encounter AND the patient has a documented follow-up plan for a BMI outside normal parameters within the previoussix months of the current visit

Definitions:
BMI – Body mass index (BMI), is a number calculated using the Quetelet index: weight divided byheight 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 (lbs) / (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 plan may include, but is not limited to:

• Documentation of education
• Referral (for example a registered dietitian, nutritionist, occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professional, or surgeon)
• Pharmacological interventions
• Dietary supplements
• Exercise counseling
• Nutrition counseling

Not Eligible for BMI Calculation or Follow-Up Plan (Denominator Exclusion) – A patient is not eligible if one or more of the following reasons are documented:

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

Patients with a documented BMI outside normal limits and a documented reason for not completing BMI follow-up plan (Denominator Exception) –

• The Medical Reason exception could include, but is not limited to, the following patients as deemed appropriate by the health care provider
  • 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
  • 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 Options:
Performance Met: BMI is documented within normal parameters and no follow-up plan is required (G8420)
OR
Performance Met: BMI is documented above normal parameters and a follow-up plan is documented (G8417)
OR
Performance Met: BMI is documented below normal parameters and a follow-up plan is documented (G8418)
OR
Denominator Exception: BMI is documented as being outside of normal limits, follow-up plan is not completed for documented reason (G9716)
OR
Performance Not Met: BMI not documented and no reason is given (G8421)
OR
Performance Not Met: BMI documented outside normal parameters, no follow-up plan documented, no reason given (G8419)