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  2. CQM-7519

Class III obesity is not included in the valueset for 2024 or 2025

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
    • Resolution: Unresolved
    • Icon: Moderate Moderate
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    • Jennifer Harlos
    • CMS1028v3
    • CMS1028v2
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      Providers are documenting class III obesity on the chart and coders are coding it, but we still aren't having this count in as a risk adjustment in the PC-07 measure. Over 40% of our patients would qualify for this coding according to their BMI. I understand the limitations of BMI, especially in the context of pregnancy, but I wonder if there could be a better way to capture this, through pulling the prepregnancy BMI from a discreet field, or pulling the admission BMI, even at a level higher than morbid obesity in a nonpregnant person, say above 45 or 50, as an additional way to capture these cases beyond just relying on a diagnosis code. This would capture this risk factor more accurately.
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      Providers are documenting class III obesity on the chart and coders are coding it, but we still aren't having this count in as a risk adjustment in the PC-07 measure. Over 40% of our patients would qualify for this coding according to their BMI. I understand the limitations of BMI, especially in the context of pregnancy, but I wonder if there could be a better way to capture this, through pulling the prepregnancy BMI from a discreet field, or pulling the admission BMI, even at a level higher than morbid obesity in a nonpregnant person, say above 45 or 50, as an additional way to capture these cases beyond just relying on a diagnosis code. This would capture this risk factor more accurately.

      My coding department is now using an E66.813 code to code for Class III (AKA morbid or severe) obesity.  This is not on the valueset for this measure for this year or next. This is already a very difficult risk factor to capture because providers most often document the BMI, but we've had to work with them a lot, with not that much success, to get them to write "morbid/severe/class III obesity" on the chart as well so that it can be coded. Now that's not even being coded to a code that is recognized on this measure.

            aweber Mathematica EH eCQM Team
            jlharlos Jennifer Harlos
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              Created:
              Updated: