BMI Screening and Follow-Up Plan Diagnoses Codes

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    • Type: EC eCQMs - Eligible Clinicians
    • Resolution: No Response From User
    • Priority: Moderate
    • Component/s: None
    • None
    • Christi Chavez
    • 9564609045
    • Access Community Health Network
    • Hide
      Thank you for your feedback on the Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan. The eCQM 2025-05-08 value sets are applicable for the 2026 performance period, which is the same for the version 14 of the Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan eCQM in your initial inquiry. The value set relevant to eCQM version 13 (2025 performance period) does not include the referenced codes. As you noted, your performance on the measure will continue to be impacted until the 2026 performance period value set codes are active.
      Show
      Thank you for your feedback on the Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan. The eCQM 2025-05-08 value sets are applicable for the 2026 performance period, which is the same for the version 14 of the Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan eCQM in your initial inquiry. The value set relevant to eCQM version 13 (2025 performance period) does not include the referenced codes. As you noted, your performance on the measure will continue to be impacted until the 2026 performance period value set codes are active.
    • CMS0069v14
    • CMS0069v13
    • CMS0069v12
    • Hide
      The value set of "overweight" (e.g., Obesity, Class I, BMI 30-34.9 [E66.811], Obesity, Class II, BMI 35-39.9 [E66.812], Obesity, Class III, BMI > = 40 [E66.813]) are not currently part of the value set. However, these have to be used to meet the HCC (Hierarchical Condition Category) coding requirements for Medicare and/or other insurances.
      Show
      The value set of "overweight" (e.g., Obesity, Class I, BMI 30-34.9 [E66.811], Obesity, Class II, BMI 35-39.9 [E66.812], Obesity, Class III, BMI > = 40 [E66.813]) are not currently part of the value set. However, these have to be used to meet the HCC (Hierarchical Condition Category) coding requirements for Medicare and/or other insurances.

      To meet the Adult BMI measure, we have created a Best Practice Alert in our EMR that lists diagnoses for providers to choose from. However, after a review of these codes by our revenue cycle team, they found that the codes that are part of the current BMI value set for the diagnosis of "overweight" (e.g., Obesity, Class I, BMI 30-34.9 [E66.811], Obesity, Class II, BMI 35-39.9 [E66.812], Obesity, Class III, BMI > = 40 [E66.813]) have to be used to meet the HCC (Hierarchical Condition Category) coding requirements for Medicare and/or other insurances. We must use these codes to meet the requirements for risk adjustment for our Medicare and other health plan payers. The codes that are part of the value set, that will meet the measure for CMS/quality will NOT meet the HCC coding requirements.  As a result, our 2025 Adult BMI rate will be impacted because the UDS value set does not include these diagnoses codes

            Assignee:
            AIR EC eCQM Team
            Reporter:
            Christi
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              Created:
              Updated:
              Resolved: