Thank you for your inquiry about CMS69v9: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan. The CMS69v9 logic was updated to reduce the overall complexity of measure definition construction. The intent was to make the definition logic less complex, easier to understand, and more meaningful. The referral reason attribute is required for all interventions, whether the intervention is documentation of education or a referral, to ensure the reason for the interention the patient being overweight/obese or underweight. The "Follow Up for Above Normal BMI" (2.16.840.1.113883.3.600.1.1525) and "Follow Up for Below Normal BMI" (2.16.840.1.113883.3.600.1.1528) value sets include concepts that represent a follow-up for abnormal BMI, such as encounter and intervention codes (e.g., dietary education). The referral reason attribute is defined using the "Overweight or Obese" (2.16.840.1.113762.1.4.1047.502) value set to identify a diagnosis of overweight or obese or the SNOMEDCT Code (248342006) to identify a finding of underweight.

Was there a specific reason why referral reason was added as a requirement for Above Normal BMI and Below Normal BMI when the value sets already represent the reason the patient is being referred? Referral Reason was only needed for Valueset "Referrals where weight assessment may occur." We are trying to understand the rational behind this change since it seems to have redundant information for 2021. I also see that this logic carries over to 2022. 2020 (High and Low BMI Sections): High BMI Follow Up Encounters "Qualifying Encounters During the Measurement Period" QualifyingEncounter with ( ["Intervention, Order": "Above Normal Follow-up"] union ["Intervention, Performed": "Above Normal Follow-up"] union ( ["Intervention, Order": "Referrals where weight assessment may occur"] Referral where Referral.reason in "Overweight or Obese" ) union ["Medication, Order": "Above Normal Medications"] ) HighBMIInterventions such that Coalesce(start of HighBMIInterventions.relevantPeriod, HighBMIInterventions.authorDatetime)12 months or less on or before end of QualifyingEncounter.relevantPeriod 2021 (Applies to both High and Low BMI Sections):  Referral Reason was now  needed for Valuesets "Referrals where weight assessment may occur" and "Follow Up for Above Normal BMI" and Follow Up for Below Normal BMI  High BMI and Follow Up Provided "Most Recent Documented BMI" MostRecentBMI   with ["Intervention, Performed": "Follow Up for Above Normal BMI"] AboveNormalFollowUp     such that MostRecentBMI.relevantDatetime 12 months or less on or before day of start of AboveNormalFollowUp.relevantPeriod       and AboveNormalFollowUp.reason in "Overweight or Obese"   where MostRecentBMI.result >= 25 'kg/m2'   High BMI and Order for Follow Up "Most Recent Documented BMI" MostRecentBMI   with ( ( ( ["Intervention, Order": "Follow Up for Above Normal BMI"]       union ["Intervention, Order": "Referrals Where Weight Assessment May Occur"] ) ReferralHighBMI       where ReferralHighBMI.reason in "Overweight or Obese"   )     union ["Medication, Order": "Medications for Above Normal BMI"] ) HighBMIIntervention     such that MostRecentBMI.relevantDatetime 12 months or less on or before day of HighBMIIntervention.authorDatetime   where MostRecentBMI.result >= 25 'kg/m2'