​Thank you for your inquiry about CMS 69 Preventive Care and Screening: Body Mass Index Screening and Follow-Up Plan. We appreciate the benefits of using an adjusted BMI for the population your organization serves. The measure definition and guidance, however, are based upon the Quetelet index: weight divided by height squared (W/H2). Adjusted BMI formulas for factors such as amputation are not currently included in the guidance. CMS69 does have a denominator exception for patients with a documented medical reason for not documenting a follow-up plan for a BMI outside normal parameters. Because the BMI formula defined in the measure may provide significantly inaccurate results for some amputees which per the measure specifications would then require an intervention, documentation of a medical reason for not providing an intervention would be appropriate and would remove that patient case from the measure. Medical reasons for not documenting a follow up plan for Low or High BMI are identified by the SNOMED codes included in the Medical Reason value set (2.16.840.1.113883.3.526.3.1007). We appreciate you bringing this issue to our attention and will pass it on the measure developer for consideration in a future measure update.  

Our organization will be building flowsheets to capture amputation adjusted BMIs. I have not been able to find any information on line about whether these should be considered for CMS-69 BMI Screening. Can you please offer some guidance on which BMI to use for the measure if both are available?