Documentation of underweight/overweight/obesity diagnosis codes

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    • Type: Other
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
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      Thank you for inquiring about the Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan measure. Pardon the delayed response; the ticket was routed to the wrong JIRA project.

      A diagnosis is not required for the measure. Please note that the measure allows for either 1) an overweight or obese diagnosis starting before or the day of the intervention or 2) a documented high BMI with an intervention ordered or performed and directly linked to the abnormal result to meet the numerator criterion for overweight with follow-up. Therefore, if your site captures a BMI of 25+ during the measurement period (reflected in the measure definition “Documented High BMI during Measurement Period” for the v.12 measure) and appropriate follow-up was documented (and directly associated with the abnormal BMI result), that will suffice. Alternatively, if your site captures a BMI of 25+ during the measurement period and follow-up was documented but NOT directly associated with the abnormal BMI result, then you would need to have documented the obese diagnosis, which would need to overlap before the intervention is performed or be documented on the day of the intervention order to meet the numerator.
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      Thank you for inquiring about the Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan measure. Pardon the delayed response; the ticket was routed to the wrong JIRA project. A diagnosis is not required for the measure. Please note that the measure allows for either 1) an overweight or obese diagnosis starting before or the day of the intervention or 2) a documented high BMI with an intervention ordered or performed and directly linked to the abnormal result to meet the numerator criterion for overweight with follow-up. Therefore, if your site captures a BMI of 25+ during the measurement period (reflected in the measure definition “Documented High BMI during Measurement Period” for the v.12 measure) and appropriate follow-up was documented (and directly associated with the abnormal BMI result), that will suffice. Alternatively, if your site captures a BMI of 25+ during the measurement period and follow-up was documented but NOT directly associated with the abnormal BMI result, then you would need to have documented the obese diagnosis, which would need to overlap before the intervention is performed or be documented on the day of the intervention order to meet the numerator.
    • Not measure related

      In regard to CMSv11 (Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan) can you please explain if it is a requirement to document a diagnosis of overweight or obesity if the patients BMI falls into that category? For example: The patient has a BMI of 26. Does the provider need to enter diagnosis code of E66.3 in addition to documentation of diet and exercise recommendations? Or is it sufficient for the BMI of 26 to be documented followed by the documentation of a follow up plan for weight reduction (No supporting code)?

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Britney Welch (Inactive)
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            1 Vote for this issue
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              Created:
              Updated:
              Resolved: