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  2. CQM-1875

CMS 69 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan: Encounter, BMI, and Follow-Up timeframes

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      To address your numbered questions based on the scenario presented:
       
      1) Yes
       
      2) Correct
       
      3) There must be a qualifying CPT code (encounter), either concurrent with or later than the recorded BMI. In your scenario the BMI on 10/1/2015 would not count towards the measure unless there was a qualifying encounter on or later than 10/1/2015.
       
      4) see #5 below.
       
      5) The intervention timeframe would be within six months prior to the encounter on 3/31/2015, no matter when the BMI is recorded.
       
      6) see #3 above.
       
      7) In order for the 10/1/2015 BMI to count towards the measure there would need to be a qualifying encounter on or after 10/1/2015. If there was such an encounter the timeframe for intervention would be within 6 months of that encounter.
       
      I would like to add that we very much appreciate Eric Gunter's feedback. This eCQM is a retooled version of an existing claims and registry measure and mimics the structure of those specifications. We will be looking for opportunities to simplify and improve the clarity of the measure logic going forward.
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      To address your numbered questions based on the scenario presented:   1) Yes   2) Correct   3) There must be a qualifying CPT code (encounter), either concurrent with or later than the recorded BMI. In your scenario the BMI on 10/1/2015 would not count towards the measure unless there was a qualifying encounter on or later than 10/1/2015.   4) see #5 below.   5) The intervention timeframe would be within six months prior to the encounter on 3/31/2015, no matter when the BMI is recorded.   6) see #3 above.   7) In order for the 10/1/2015 BMI to count towards the measure there would need to be a qualifying encounter on or after 10/1/2015. If there was such an encounter the timeframe for intervention would be within 6 months of that encounter.   I would like to add that we very much appreciate Eric Gunter's feedback. This eCQM is a retooled version of an existing claims and registry measure and mimics the structure of those specifications. We will be looking for opportunities to simplify and improve the clarity of the measure logic going forward.

      I would like guidance on how to interpret the timeframes for the encounter, the BMI, and the intervention/follow-up for CMS 69v3: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan.

      I understand that we want to always look to the most recent BMI if there is more than one recorded. However, I want a more explicitly defined timeframe for this BMI. Is the date that the BMI must be recorded defined by the encounter/CPT code? Does the BMI have to be on or within six months prior to the encounter? If there is a BMI recorded that occurs after the specified CPT code, but within the reporting period, do we still count this BMI? In addition, I want to better understand the timeframe for the intervention or follow-up. Is this timeframe defined by the qualifying encounter/CPT codes or is it defined by the date of the out of range BMI?

      For example, take the reporting period defined as 1/1/2015-12/31/2015, and a patient who had an encounter with one of the qualifying CPT codes on 3/31/2015.

      1) Is the BMI timeframe defined as six months before a qualifying encounter/CPT code (3/31/2015)?
      2) If this is the timeframe, a BMI recorded on 9/1/2014 would qualify for the measure, but a BMI recorded on 8/31/2014 would not qualify for this measure. Is this reasoning correct?
      3) If the patient has a more recent BMI recorded (let’s say on 10/1/2015), but the only qualifying CPT code this patient has during the reporting period is on 3/31/2015, does this more recent BMI recorded on 10/1/2015 still count towards this measure? Or would we still default back to the BMI recorded on 9/1/2014?
      4) If the BMI recorded on 9/1/2014 was out of range, does the date of this BMI define the timeframe for intervention? Would the intervention timeframe in this example be six months prior to 9/1/2014?
      5) OR is the intervention timeframe defined by the qualifying encounter with the specific CPT codes? If this is the case, then does the intervention have to occur within six months prior to 3/31/2015, no matter when the BMI is recorded?
      6) If we can, in fact, count a BMI recorded after a qualifying encounter/CPT code, then does the date of this BMI define the intervention period? For example, if the most recent BMI documented occurs on 10/1/2015, is the intervention timeframe within six months prior to this date?
      7) OR would the intervention timeframe be six months prior to 3/31/2015 up to the date of the recorded BMI (10/1/2015)?

      Thank you.

            edave Mathematica EC eCQM Team
            rneibel Rosa Neibel (Inactive)
            Rosa Neibel (Inactive)
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