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  2. CQM-5645

CMS69: Query Regarding Documentation of Overwieght Codes

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    • Icon: EC eCQMs EC eCQMs
    • Resolution: Answered
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    • Snehprabha Mohite
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      ​​For CMS69v10 (PY2022), while the documented BMI value is the criteria evaluated to determine a reason for a follow-up plan, the reason attribute is required for all interventions in order to meet the numerator criteria. Required reason codes for follow-up plans associated with an above or below normal BMI can be found in the terminology section of the logic:

      code "Underweight (finding)" ("SNOMEDCT Code (248342006)"
      valueset "Overweight or Obese" (2.16.840.1.113762.1.4.1047.502)
      For CMS69v11 (PY2023), the logic was revised to add a diagnosis option in addition to the reason attribute. Underweight, overweight, or obese BMIs can be captured as diagnoses, providing an alternate way to capture the intent and applicability of the intervention.

      High BMI Interventions Performed

      ( ["Intervention, Performed": "Follow Up for Above Normal BMI"] HighInterventionsPerformed
          where HighInterventionsPerformed.reason in "Overweight or Obese"
            or ( exists ["Diagnosis": "Overweight or Obese"] OverweightObese
                where OverweightObese.prevalencePeriod starts before or on day of Global."NormalizeInterval" ( HighInterventionsPerformed.relevantDatetime, HighInterventionsPerformed.relevantPeriod )
                  and not ( OverweightObese.prevalencePeriod ends before day of Global."NormalizeInterval" ( HighInterventionsPerformed.relevantDatetime, HighInterventionsPerformed.relevantPeriod ) )
                  and Global."NormalizeInterval" ( HighInterventionsPerformed.relevantDatetime, HighInterventionsPerformed.relevantPeriod ) during "Measurement Period"
            )
      )
      Low BMI Interventions Performed

      ( ["Intervention, Performed": "Follow Up for Below Normal BMI"] LowInterventionsPerformed
          where LowInterventionsPerformed.reason in "Underweight"
            or ( exists ["Diagnosis": "Underweight"] Underweight
                where Underweight.prevalencePeriod starts before or on day of Global."NormalizeInterval" ( LowInterventionsPerformed.relevantDatetime, LowInterventionsPerformed.relevantPeriod )
                  and not ( Underweight.prevalencePeriod ends before day of Global."NormalizeInterval" ( LowInterventionsPerformed.relevantDatetime, LowInterventionsPerformed.relevantPeriod ) )
                  and Global."NormalizeInterval" ( LowInterventionsPerformed.relevantDatetime, LowInterventionsPerformed.relevantPeriod ) during "Measurement Period"
            )
      )
      Show
      ​​For CMS69v10 (PY2022), while the documented BMI value is the criteria evaluated to determine a reason for a follow-up plan, the reason attribute is required for all interventions in order to meet the numerator criteria. Required reason codes for follow-up plans associated with an above or below normal BMI can be found in the terminology section of the logic: code "Underweight (finding)" ("SNOMEDCT Code (248342006)" valueset "Overweight or Obese" (2.16.840.1.113762.1.4.1047.502) For CMS69v11 (PY2023), the logic was revised to add a diagnosis option in addition to the reason attribute. Underweight, overweight, or obese BMIs can be captured as diagnoses, providing an alternate way to capture the intent and applicability of the intervention. High BMI Interventions Performed ( ["Intervention, Performed": "Follow Up for Above Normal BMI"] HighInterventionsPerformed     where HighInterventionsPerformed.reason in "Overweight or Obese"       or ( exists ["Diagnosis": "Overweight or Obese"] OverweightObese           where OverweightObese.prevalencePeriod starts before or on day of Global."NormalizeInterval" ( HighInterventionsPerformed.relevantDatetime, HighInterventionsPerformed.relevantPeriod )             and not ( OverweightObese.prevalencePeriod ends before day of Global."NormalizeInterval" ( HighInterventionsPerformed.relevantDatetime, HighInterventionsPerformed.relevantPeriod ) )             and Global."NormalizeInterval" ( HighInterventionsPerformed.relevantDatetime, HighInterventionsPerformed.relevantPeriod ) during "Measurement Period"       ) ) Low BMI Interventions Performed ( ["Intervention, Performed": "Follow Up for Below Normal BMI"] LowInterventionsPerformed     where LowInterventionsPerformed.reason in "Underweight"       or ( exists ["Diagnosis": "Underweight"] Underweight           where Underweight.prevalencePeriod starts before or on day of Global."NormalizeInterval" ( LowInterventionsPerformed.relevantDatetime, LowInterventionsPerformed.relevantPeriod )             and not ( Underweight.prevalencePeriod ends before day of Global."NormalizeInterval" ( LowInterventionsPerformed.relevantDatetime, LowInterventionsPerformed.relevantPeriod ) )             and Global."NormalizeInterval" ( LowInterventionsPerformed.relevantDatetime, LowInterventionsPerformed.relevantPeriod ) during "Measurement Period"       ) )
    • CMS0069v11
    • CMS0069v10

      Hello Team,
       
      We had a query regarding measure CMS69v10/ v11. 
       
      Please find the measure details and query below:
       
      Measure Description: Percentage of patients aged 18 years and older with a BMI documented during the current encounter or within the previous twelve months AND who had a follow-up plan documented if most recent BMI was outside of normal parameters.

      Our Query - If we are getting high BMI documented, and the case has a followup like weight management documented, would we still need a reason for the patient being overweight/obese  to be documented, or we can assume that patient would be overweight/ obese, which is why the follow up is given for weight management

      Please find an example for this:

      BMI documented >25 Kg/m2

      Follow up - Weight Management and Nutritional Counseling

      Similar for this would go for underweight and low BMI conditions as well. 

      Hope this clarifies. Please let us know if you need any more information.

            edave Mathematica EC eCQM Team
            Snehprabha Mohite Snehprabha Mohite (Inactive)
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