Metadata
Title | Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up PlanFHIR
Version | 1.0.000
Short Name | CMS69FHIR
GUID (Version Independent) | urn:uuid:5d929142-0109-4dc3-97b5-27c9296b3cf9
GUID (Version Specific) | urn:uuid:6788e67b-9cd5-40f8-a8fd-75540dc16238
CMS Identifier | 69FHIR
Effective Period | 2026-01-01 through 2026-12-31
Steward (Publisher) | Centers for Medicare & Medicaid Services (CMS)
Developer | American Institutes for Research (AIR)
Description | Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the measurement period AND who had a follow-up plan documented if BMI was outside of normal parameters
Copyright | This electronic clinical quality measure (Measure) and related data specifications are owned and stewarded by the Centers for Medicare & Medicaid Services (CMS). CMS contracted (Contract # 75FCMC18D0027/ Task Order #: 75FCMC24F0144) with the American Institutes for Research (AIR) to develop this electronic measure. AIR is not responsible for any use of the Measure. AIR makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and AIR has no liability to anyone who relies on such measures or specifications. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. AIR disclaims all liability for use or accuracy of any third-party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2024 American Medical Association. LOINC(R) is copyright 2004-2024 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2024 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2024 World Health Organization. All Rights Reserved.
Disclaimer | These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Rationale | BMI Above Normal Parameters “Obesity is a chronic, multifactorial disease with complex psychological, environmental (social and cultural), genetic, physiologic, metabolic, and behavioral causes and consequences. The prevalence of overweight and obese people is increasing worldwide at an alarming rate in both developing and developed countries. Environmental and behavioral changes brought about by economic development, modernization, and urbanization have been linked to the rise in global obesity. The health consequences are becoming apparent” (Fitch et al., 2013). More than a third of United States (U.S.) adults have a body mass index (BMI) >= 30 kg/m2 and are at increased risk for diabetes, cardiovascular disease (CVD), and obstructive sleep apnea (Flegal et al., 2012; Ogden et al., 2015; Dong et al., 2020). Hales et al. (2017) reported that the prevalence of obesity among adults and youth in the U.S. was 39.8 percent and 18.5 percent, respectively, from 2015-2016. Furthermore, the prevalence of obesity in adults increased to 42.4 percent in 2018, with the highest percentage among adults in the 40-59 age bracket compared with other age groups (Hales et al., 2020). Hales et al. (2020) also disaggregated the data according to race/ethnicity and noted that obesity prevalence was higher among non-Hispanic Black adults and Hispanic adults when compared with other races and ethnicities. Obesity prevalence was lowest among non-Hispanic Asian men and women. Among males, obesity prevalence was higher among Hispanic males compared with non-Hispanic Black males and non-Hispanic White males. Among females, the prevalence among non-Hispanic Black females was 56.9 percent, which was higher than all other races/ethnicities. In general, the prevalence of obesity in the U.S. remains higher than the Healthy People 2020 goal of 30.5 percent among adults (Hales et al., 2020). BMI continues to be a common and reasonably reliable measurement to identify overweight and obese adults who may be at an increased risk for future morbidity. Although good quality evidence supports obtaining a BMI, it is important to recognize it is not a perfect measurement. For example, BMI and its associated disease and mortality risk appear to vary among ethnic subgroups. Black/African Americans appear to have the lowest mortality risk at a BMI of 26.2-28.5 kg/m2 in Black women and 27.1-30.2 kg/m2 in Black men. In contrast, Asian populations may experience the lowest mortality rates, starting at a BMI of 23 to 24 kg/m2. The correlation between BMI and diabetes risk also varies by ethnicity (LeBlanc et al., 2011). BMI is not a direct measure of adiposity; consequently, it can over or underestimate adiposity. However, overall, BMI is a derived value that correlates well with total body fat and markers of secondary complications, e.g., hypertension and dyslipidemia (Barlow & the Expert Committee, 2007). It is important to enhance beneficiary access to appropriate treatments for obesity, which could result in decreased healthcare costs and lower obesity rates. Behavioral weight management treatment has been identified as an effective first-line treatment for obesity, with an average initial weight loss of 8-10 percent. This percentage of weight loss is associated with a significant risk reduction for diabetes and CVD (Wadden, Butryn & Wilson, 2007). Evidence also shows that when provided 14 or more high-intensity behavioral intervention sessions of face-to-face individual or group treatment across 6 months, participants lose up to 8 percent of their weight during that time and experience improvements in heart disease risk factors and quality of life (Wadden, Tronieri, & Butryn, 2020). There is also evidence that high-intensity behavioral counseling is effective, whether delivered in-person, by phone, or electronically (Tronieri et al., 2019). Moreover, intensive behavioral therapy for obesity provided by registered dietitian nutritionists for 6-12 months shows a significant mean weight loss of up to 10 percent of body weight, maintained over one year’s time (Raynor & Champagne, 2016). Despite the evidence that supports weight management counseling, the rate of use in primary care for patients with obesity decreased by 10 percent from 39.9 percent in 1995-1996 to 29.9 percent in 2007-2008 (Kraschnewski et al., 2013). Weight management counseling during primary care visits further declined from 33 percent to 21 percent between 2008-2009 and 2012-2013. This suggests that obesity management in primary care remains suboptimal (Fitzpatrick & Stevens, 2017). Therefore, screening for BMI and follow-up is critical and will help in reaching the quality goals of population health and cost reduction. However, due to concerns for other underlying conditions (such as bone health) or nutrition-related deficiencies, providers are cautioned to use their best clinical judgment when considering weight management programs for overweight patients, especially the elderly (National Heart, Lung, and Blood Institute [NHLBI] Obesity Education Initiative, 1998). BMI Below Normal Parameters On the other end of the body weight spectrum is underweight (BMI < 18.5 kg/m2), which is also detrimental to population health. When compared to normal-weight individuals (BMI 18.5-25 kg/m2), underweight individuals have significantly higher death rates with a Hazard Ratio of 2.27 and 95 percent confidence intervals = 1.78, 2.90 (Borrell & Samuel, 2014). Individuals with a BMI < 18.5 kg/m2 have been shown to be at a higher risk for adverse events, postoperative infection, and/or mortality following a surgical procedure (Katakam et al., 2021; Ottesen et al., 2020; Ottesen et al., 2022; Rudasill et al., 2021). BMI below normal parameters is a risk factor for developing severe illness from respiratory infections such as influenza and COVID-19 (Moser et al., 2019; Ye et al., 2021). BMI below normal parameters can negatively impact both male and female fertility (Boutari et al., 2020; Guo et al., 2019). Poor nutrition or underlying health conditions can result in underweight (Fryar & Ogden, 2012). The National Health and Nutrition Examination Survey (NHANES) results from 2007-2010 indicate that women are more likely to be underweight than men (Fryar & Ogden, 2012). However, all patients should be equally screened for underweight and followed up with nutritional counseling or another clinically appropriate intervention to reduce mortality and morbidity associated with underweight.
Clinical Recommendation Statement | All adults should be screened annually using a BMI measurement. BMI measurements >= 25 kg/m2 should be used to initiate further evaluation of overweight or obesity after taking into account age, gender, ethnicity, fluid status, and muscularity; therefore, clinical evaluation and judgment must be used when BMI is employed as the anthropometric indicator of excess adiposity, particularly in athletes and those with sarcopenia (Garvey et al., 2016) (Grade A). Overweight and Underweight Categories: Underweight < 18.5; Normal weight 18.5-24.9; Overweight 25-29.9; Obese class I 30-34.9; Obese class II 35-39.9; Obese class III >= 40 (Garvey et al., 2016). BMI cutoff point value of >= 23 kg/m2 should be used in the screening and confirmation of excess adiposity in Asian adults (Garvey et al., 2016) (Grade B). Lifestyle/behavioral therapy for overweight and obesity should include behavioral interventions that enhance adherence to prescriptions for a reduced-calorie meal plan and increased physical activity (behavioral interventions can include: self-monitoring of weight, food intake, and physical activity; clear and reasonable goal-setting; education pertaining to obesity, nutrition, and physical activity; face-to-face and group meetings; stimulus control; systematic approaches for problem-solving; stress reduction; cognitive restructuring [i.e., cognitive behavioral therapy], motivational interviewing; behavioral contracting; psychological counseling; and mobilization of social support structures) (Garvey et al., 2016) (Grade A). Behavioral lifestyle intervention should be tailored to a patient's ethnic, cultural, socioeconomic, and educational background (Garvey et al., 2016) (Grade B). The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians offer or refer adults with a BMI of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions (USPSTF, 2018) (Grade B). Interventions: Effective intensive behavioral interventions were designed to help participants achieve or maintain weight loss of at least five percent through a combination of dietary changes and increased physical activity Most interventions lasted for one to two years, and the majority had at least 12 sessions in the first year Most behavioral interventions focused on problem-solving to identify barriers, self-monitoring of weight, peer support, and relapse prevention Interventions also provided tools to support weight loss or weight loss maintenance (e.g., pedometers, food scales, or exercise videos) (USPSTF, 2018) Nutritional safety for the elderly should be considered when recommending weight reduction. "A clinical decision to forego obesity treatment in older adults should be guided by an evaluation of the potential benefits of weight reduction for day-to-day functioning and reduction of the risk of future cardiovascular events, as well as the patient's motivation for weight reduction. Care must be taken to ensure that any weight reduction program minimizes the likelihood of adverse effects on bone health or other aspects of nutritional status" (NHLBI Obesity Education Initiative, 1998) (Evidence Category D). In addition, weight reduction prescriptions in older persons should be accompanied by proper nutritional counseling and regular body weight monitoring (NHLBI Obesity Education Initiative, 1998). The possibility that a standard approach to weight loss will work differently in diverse patient populations must be considered when setting expectations about treatment outcomes (NHLBI Obesity Education Initiative, 1998) (Evidence Category B).
Citation | Barlow, S. E., & the Expert Committee. (2007). Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: Summary report. Pediatrics, 120(Suppl. 4), S164-S192. doi:10.1542/peds.2007-2329C
Citation | Borrell, L. N., & Samuel, L. (2014). Body mass index categories and mortality risk in U.S. adults: The effect of overweight and obesity on advancing death. American Journal of Public Health, 104(3), 512-519. doi:10.2105/AJPH.2013.301597
Citation | Boutari, C., Pappas, P. D., Mintziori, G., Nigdelis, M. P., Athanasiadis, L., Goulis, D. G., & Mantzoros, C. S. (2020). The effect of underweight on female and male reproduction. Metabolism, 107, 154229. https://doi.org/10.1016/j.metabol.2020.154229
Citation | Centers for Disease Control and Prevention (CDC). (2012). National Health and Nutrition Examination Survey (NHANES). Prevalence of underweight among adults aged 20 and over: United States, 1960–1962 Through 2011–2012. Retrieved from https://www.cdc.gov/nchs/data/hestat/underweight_adult_11_12/underweight_adult_11_12.htm
Citation | Diehr, P., O’Meara, E. S., Fitzpatrick A., Newman, A. B., Kuller, L., Burke, G. (2008). Weight, mortality, years of healthy life, and active life expectancy in older adults. Journal of the American Geriatrics Society, 56(1), 76-83. https://doi.org/10.1111/j.1532-5415.2007.01500.x
Citation | Dong, Z., Xu, X., Wang, C., Cartledge, S., Maddison, R., & Mohammed Shariful Islam, S. (2020). Association of overweight and obesity with obstructive sleep apnoea: A systematic review and meta-analysis. Obesity Medicine, 17. doi:https://doi.org/10.1016/j.obmed.2020.100185
Citation | Donini, L. M., Savina, C., Gennaro, E., De Felice, M. R., Rosano, A., Pandolfo, M. M., Del Balzo, V., …Chumlea, W. C. et al. (2012). A systematic review of the literature concerning the relationship between obesity and mortality in the elderly. The Journal of Nutrition, Health & Aging, 16(1), 89-98. doi:10.1007/s12603-011-0073-x
Citation | Fitch, A., Everling, L., Fox, C.,Goldberg, J., Heim, C., Johnson, K., …Webb, B. (2013, May). Prevention and management of obesity for adults. Bloomington, MN: Institute for Clinical Systems Improvement.
Citation | Fitzpatrick, S. L., & Stevens, V. J. (2017). Adult obesity management in primary care, 2008-2013. Preventive medicine, 99, 128–133. https://doi.org/10.1016/j.ypmed.2017.02.020
Citation | Flegal, K. M., Carroll, M. D., Kit, B. K., & Ogden, C. L. (2012). Prevalence of obesity and trends in the distribution of body mass index among U. S. adults, 1999-2010. JAMA, 307(5), 491-497. doi.10.1001/jama.2012.39
Citation | Fryar, C. D., & Ogden, C. L. (2012). Prevalence of underweight among adults aged 20 and over: United States, 1960-1962 through 2007-2010. Hyattsville, MD: NCHS, Division of Health and Nutrition Examination Surveys. Retrieved from http://www.cdc.gov/nchs/data/hestat/underweight_adult_07_10/underweight_adult_07_10.pdf
Citation | Garvey, W. T., Mechanick, J. I., Brett, E. M., Garber, A. J., Hurley, D. L., Jastrebodd. A. M., …and Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. (2016). American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive clinical practice guidelines for medical care of patients with obesity. Endocrine Practice, 22(Suppl. 3), 1-203. https://doi.org/10.4158/EP161365.GL
Citation | Guo, D., Xu, M., Zhou, Q., Wu, C., Ju, R., & Dai, J. (2019). Is low body mass index a risk factor for semen quality? A PRISMA -compliant meta-analysis. Medicine, 98(32), e16677. https://doi.org/10.1097/MD.0000000000016677
Citation | Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C.L. (2020). Prevalence of Obesity and Severe Obesity Among Adults: United States, 2017-2018. NCHS Data Brief No. 360. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db360.htm
Citation | Hales, C. M., Carroll, M. D., Fryar, C. D., et al. (2017). Prevalence of obesity among adults and youth: United States, 2015-2016. NCHS Data Brief No. 288. Retrieved from https://www.cdc.gov/nchs/products/databriefs/db288.htm
Citation | Holme, I., & Tonstad, S. (2015). Survival in elderly men in relation to midlife and current BMI. Age and Ageing, 44(3), 434-439
Citation | Katakam , A., Melnic, C. M., Bragdon, C. R., Sauder, N., Collins, A. K., & Bedair, H. S. (2021). Low body mass index is a predictor for mortality and increased length of stay following total joint arthroplasty. The Journal of Arthroplasty, 36(1), 72-77. https://doi.org/10.1016/j.arth.2020.07.055
Citation | Kraschnewski, J. L., Sciamanna, C. N., Stuckey, H. L., Chuang, C. H., Lehman, E. B., Hwang, K. O., Sherwood, L. L., & Nembhard, H. B. (2013). A silent response to the obesity epidemic: decline in US physician weight counseling. Medical care, 51(2), 186–192. https://doi.org/10.1097/MLR.0b013e3182726c33
Citation | LeBlanc, E., O’Connor, E., Whitlock, E. P., et al. (2011). Screening for and management of obesity and overweight in adults (Evidence Report No. 89; AHRQ Publication No. 11-05159-EF-1). Rockville, MD: Agency for Healthcare Research and Quality
Citation | Moser, J. S., Galindo-Fraga, A., Ortiz-Hernández, A. A., Gu, W., Hunsberger, S., Galán-Herrera, J. F., Guerrero, M. L., Ruiz-Palacios, G. M., Beigel, J. H., & La Red ILI 002 Study Group. (2019). Underweight, overweight, and obesity as independent risk factors for hospitalization in adults and children from influenza and other respiratory viruses. Influenza and Other Respiratory Viruses, 13(1), 3-9. https://doi.org/10.1111/irv.12618
Citation | NHLBI Obesity Education Initiative. (1998). Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults (Report No. 98-4083). Bethesda, MD: NHLBI
Citation | Ogden, C.L., Carroll, M.D., Fryar, C.D., Flegal, K.M. (2015). Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS data brief, no 219. Hyattsville, MD: National Center for Health Statistics. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db219.pdf
Citation | Ottesen, T. D., Galivanche, A. R., Greene, J. D., Malpani, R., Varthi, A. G., & Grauer, J. N. (2022). Underweight patients are the highest risk body mass index group for perioperative adverse events following stand-alone anterior lumbar interbody fusion. The Spine Journal: Official Journal of the North American Spine Society, 22(7), 1139-1148. https://doi.org/10.1016/j.spinee.2022.02.012
Citation | Ottesen, T. D., Malpani, R., Galivanche, A. R., Zogg, C. K., Varthi, A. G., & Grauer, J. N. (2020). Underweight patients are at just as much risk as super morbidly obese patients when undergoing anterior cervical spine surgery. The Spine Journal: Official Journal of the North American Spine Society, 20(7), 1085-1095. https://doi.org/10.1016/j.spinee.2020.03.007
Citation | Raynor, H. A., & Champagne, C. M. (2016). Position of the Academy of Nutrition and Dietetics: Interventions for the treatment of overweight and obesity in adults. Journal of the Academy of Nutrition and Dietetics, 116(1), 129-147. doi:10.1016/jand.2015.10.031
Citation | Rudasill, S. E., Dillon, D., Karunungan, K., Mardock, A. L., Hadaya, J., Sanaiha, Y., Tran, Z., & Benharash, P. (2021). The obesity paradox: Underweight patients are at the greatest risk of mortality after cholecystectomy. Surgery, 170(3), 675-681. https://doi.org/10.1016/j.surg.2021.03.034
Citation | Tronieri, J. S., Wadden, T. A., Chao, A. M., & Tsai, A. G. (2019). Primary Care Interventions for Obesity: Review of the Evidence. Current obesity reports, 8(2), 128–136. https://doi.org/10.1007/s13679-019-00341-5
Citation | U.S. Preventive Services Task Force (USPSTF). (2018). Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: U.S. Preventive Services Task Force recommendation statement. JAMA, 320(11), 1163–1171. doi:10.1001/jama.2018.13022
Citation | Wadden, T. A, Butryn, M. L., Wilson, C. (2007). Lifestyle modification for the management of obesity. Gastroenterology, 132 (6), 2226-2238. doi: 10.1053/j.gastro.2007.03.051
Citation | Wadden, T. A., Tronieri, J. S., & Butryn, M. L. (2020). Lifestyle modification approaches for the treatment of obesity in adults. American Psychologist, 75(2), 235–251
Citation | Ye, P., Pang, R., Li, L., Li, H. R., Liu, S. L., & Zhao, L. (2021). Both underweight and obesity are associated with an increased risk of coronavirus disease 2019 (COVID-19) severity. Frontiers in Nutrition, 8, 649422. https://doi.org/10.3389/fnut.2021.649422
Guidance (Usage) | This eCQM is a patient-based measure. This measure is to be reported a minimum of once per measurement period for patients seen during the measurement period. This measure may be reported by eligible clinicians who perform the quality actions described in the measure based on the services provided at the time of the qualifying encounter or during the measurement period and the measure-specific denominator coding. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. BMI Measurement Guidance: Height and Weight An eligible clinician or their staff is required to measure both height and weight. Both height and weight must be measured during the measurement period. Self-reported values cannot be used. The BMI may be documented in the provider's medical record or outside medical records obtained by the provider. If the documented BMI is outside of normal parameters, then a follow-up plan is documented during the encounter or measurement period. If more than one BMI is reported during the measurement period, and any of the documented BMI assessments is outside of normal parameters, documentation of an appropriate follow-up plan will be used to determine if performance has been met. Review the exclusions and exceptions criteria to determine those patients that BMI measurement may not be appropriate or necessary. Follow-Up Plan Guidance: The documented follow-up plan must be based on the documented BMI, outside of normal parameters, for example: "Patient referred to nutrition counseling for BMI above or below normal parameters." See the Definition section for examples of follow-up plan treatments. Variation has been noted in studies exploring optimal BMI ranges for the elderly (see Donini et al., 2012; Holme & Tonstad, 2015; Diehr et al., 2008). Notably, however, all these studies have arrived at ranges that differ from the standard range for ages 18 and older, which is >= 18.5 and < 25 kg/m2. For instance, both Donini et al. and Holme and Tonstad reported findings that suggest that a higher BMI (higher than the upper end of 25 kg/m2) in the elderly may be beneficial. Similarly, worse outcomes have been associated with being underweight (at a threshold higher than 18.5 kg/m2) at age 65 (Diehr et al., 2008). Because of optimal BMI range variation recommendations from these studies, no specific optimal BMI range for the elderly is used. However, exempting certain patients from a follow-up plan may be appropriate by applying the exception criteria. See Denominator Exception section for examples. Denominator Exception Guidance: If a patient meets exception criteria for the denominator (i.e., the patient refuses height or weight measurement or has a documented medical reason for not documenting BMI or a follow-up plan), an eligible clinician must document those criteria on the same day as the qualifying encounter. This FHIR-based measure has been derived from the QDM-based measure CMS69v14. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU6/) for more information on QI-Core and mapping recommendations from QDM to QI-Core STU 6 (https://hl7.org/fhir/us/qicore/STU6/qdm-to-qicore.html).
Measure Group (Rate) (ID: Group_1)
Summary | Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the measurement period AND who had a follow-up plan documented if BMI was outside of normal parameters
Basis | boolean
Scoring | [http://terminology.hl7.org/CodeSystem/measure-scoring#proportion: 'Proportion']
Type | [http://terminology.hl7.org/CodeSystem/measure-type#process: 'Process']
Improvement Notation | [http://terminology.hl7.org/CodeSystem/measure-improvement-notation#increase: 'Increased score indicates improvement']
Initial Population | ID: InitialPopulation_1 Description: All patients aged 18 and older on the date of the encounter with at least one qualifying encounter during the measurement period Logic Definition: Initial Population
Denominator | ID: Denominator_1 Description: Equals Initial Population Logic Definition: Denominator
Denominator Exclusion | ID: DenominatorExclusion_1 Description: Patients who are pregnant at any time during the measurement period. Patients receiving palliative or hospice care at any time during the measurement period. Logic Definition: Denominator Exclusions
Numerator | ID: Numerator_1 Description: Patients with a documented BMI during the encounter or during the measurement period, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the measurement period Logic Definition: Numerator
Denominator Exception | ID: DenominatorException_1 Description: Patients with a documented medical reason for not documenting BMI or for not documenting a follow-up plan for a BMI outside normal parameters (e.g., elderly patients 65 years of age or older for whom weight reduction/weight gain would complicate other underlying health conditions such as illness or physical disability, mental illness, dementia, confusion, or nutritional deficiency such as vitamin/mineral deficiency; patients in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status). Patients who refuse measurement of height and/or weight. Logic Definition: Denominator Exceptions
Supplemental Data Guidance | For every patient evaluated by this measure also identify payer, race, ethnicity and sex
Supplemental Data Elements
Supplemental Data Element | ID: sde-ethnicity Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Ethnicity Logic Definition: SDE Ethnicity
Supplemental Data Element | ID: sde-payer Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Payer Logic Definition: SDE Payer
Supplemental Data Element | ID: sde-race Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Race Logic Definition: SDE Race
Supplemental Data Element | ID: sde-sex Usage Code: [http://terminology.hl7.org/CodeSystem/measure-data-usage#supplemental-data] Description: SDE Sex Logic Definition: SDE Sex
Measure Logic
Primary Library | https://madie.cms.gov/Library/CMS69FHIRPCSBMIScreenAndFollowUp
Contents | Population Criteria Logic Definitions Terminology Dependencies Data Requirements
Population Criteria
Measure Group (Rate) (ID: Group_1)
Initial Population
    define "Initial Population":
      exists "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter
        where "AgeInYearsAt"(date from start of QualifyingEncounter.period) >= 18
Denominator
    define "Denominator":
      "Initial Population"
Denominator Exclusion
    define "Denominator Exclusions":
      Hospice."Has Hospice Services"
        or PalliativeCare."Has Palliative Care in the Measurement Period"
        or "Is Pregnant During Measurement Period"
Numerator
    define "Numerator":
      exists "High BMI And Follow Up Provided"
        or exists "Low BMI And Follow Up Provided"
        or "Has Normal BMI"
Denominator Exception
    define "Denominator Exceptions":
      exists "Medical Reason For Not Documenting A Follow Up Plan For Low Or High BMI"
        or exists "Medical Reason Or Patient Reason For Not Performing BMI Exam"
Logic Definitions
Logic Definition | Library Name: Hospice
    define "Has Hospice Services":
      exists ((([Encounter: "Encounter Inpatient"]).isEncounterPerformed()) InpatientEncounter
          where (InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
              or InpatientEncounter.hospitalization.dischargeDisposition ~ "Discharge to healthcare facility for hospice care (procedure)"
          )
            and InpatientEncounter.period ends during day of "Measurement Period"
      )
        or exists ((([Encounter: "Hospice Encounter"]).isEncounterPerformed()) HospiceEncounter
            where HospiceEncounter.period overlaps day of "Measurement Period"
        )
        or exists ((([ObservationScreeningAssessment: "Hospice care [Minimum Data Set]"]).isAssessmentPerformed()) HospiceAssessment
            where HospiceAssessment.value ~ "Yes (qualifier value)"
              and HospiceAssessment.effective.toInterval() overlaps day of "Measurement Period"
        )
        or exists ((([ServiceRequest: "Hospice Care Ambulatory"]).isInterventionOrder()) HospiceOrder
            where HospiceOrder.authoredOn during day of "Measurement Period"
        )
        or exists ((([Procedure: "Hospice Care Ambulatory"]).isInterventionPerformed()) HospicePerformed
            where HospicePerformed.performed.toInterval() overlaps day of "Measurement Period"
        )
        or exists ((([ConditionProblemsHealthConcerns: "Hospice Diagnosis"]
            union [ConditionEncounterDiagnosis: "Hospice Diagnosis"]).verified()) HospiceCareDiagnosis
            where HospiceCareDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
        )
Logic Definition | Library Name: PalliativeCare
    define "Has Palliative Care in the Measurement Period":
      exists ((([ObservationScreeningAssessment: "Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)"]).isAssessmentPerformed()) PalliativeAssessment
          where PalliativeAssessment.effective.toInterval() overlaps day of "Measurement Period"
      )
        or exists ((([ConditionProblemsHealthConcerns: "Palliative Care Diagnosis"]
        union [ConditionEncounterDiagnosis: "Palliative Care Diagnosis"]).verified()) PalliativeDiagnosis
            where PalliativeDiagnosis.prevalenceInterval() overlaps day of "Measurement Period"
        )
        or exists ((([Encounter: "Palliative Care Encounter"]).isEncounterPerformed()) PalliativeEncounter
            where PalliativeEncounter.period overlaps day of "Measurement Period"
        )
        or exists ((([Procedure: "Palliative Care Intervention"]).isInterventionPerformed()) PalliativeIntervention
            where PalliativeIntervention.performed.toInterval() overlaps day of "Measurement Period"
        )
Logic Definition | Library Name: SupplementalDataElements
    define "SDE Sex":
      case
        when Patient.sex = '248153007' then "Male (finding)"
        when Patient.sex = '248152002' then "Female (finding)"
        else null
      end
Logic Definition | Library Name: SupplementalDataElements
    define "SDE Payer":
      [Coverage: type in "Payer Type"] Payer
        return {
          code: Payer.type,
          period: Payer.period
        }
Logic Definition | Library Name: SupplementalDataElements
    define "SDE Ethnicity":
      Patient.ethnicity E
        return Tuple {
          codes: { E.ombCategory } union E.detailed,
          display: E.text
        }
Logic Definition | Library Name: SupplementalDataElements
    define "SDE Race":
      Patient.race R
        return Tuple {
          codes: R.ombCategory union R.detailed,
          display: R.text
        }
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "SDE Sex":
      SDE."SDE Sex"
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "BMI During Measurement Period":
      ( ( [USCoreBMIProfile] ).isObservationBMI ( ) ) BMI
        where BMI.value > 0 'kg/m2'
          and BMI.effective.toInterval ( ) during day of "Measurement Period"
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Documented High BMI During Measurement Period":
      "BMI During Measurement Period" BMI
        where BMI.value >= 25 'kg/m2'
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "High BMI Interventions Ordered":
      ( ( [ServiceRequest: "Follow Up for Above Normal BMI"]
          union [ServiceRequest: "Referrals Where Weight Assessment May Occur"]
          union [MedicationRequest: "Medications for Above Normal BMI"] ) HighInterventionsOrdered
          where HighInterventionsOrdered.reasonCode in "Overweight or Obese"
            or ( exists ( [ConditionProblemsHealthConcerns: "Overweight or Obese"]
                union [ConditionEncounterDiagnosis: "Overweight or Obese"] ) OverweightObese
                where OverweightObese.prevalenceInterval ( ) starts before or on day of HighInterventionsOrdered.authoredOn
            )
      )
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "High BMI Interventions Performed":
      ( [Procedure: "Follow Up for Above Normal BMI"] HighInterventionsPerformed
          where HighInterventionsPerformed.reasonCode in "Overweight or Obese"
            or ( exists [ConditionProblemsHealthConcerns: "Overweight or Obese"] OverweightObese
                where OverweightObese.prevalenceInterval ( ) starts before or on day of start of HighInterventionsPerformed.performed.toInterval ( )
                  and not ( OverweightObese.prevalenceInterval ( ) ends before day of start of HighInterventionsPerformed.performed.toInterval ( ) )
            )
      )
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "High BMI And Follow Up Provided":
      "Documented High BMI During Measurement Period" HighBMI
        with ( "High BMI Interventions Ordered"
          union "High BMI Interventions Performed" ) HighBMIInterventions
          such that Coalesce(HighBMIInterventions.performed.toInterval(), HighBMIInterventions.authoredOn.toInterval()) starts during day of "Measurement Period"
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Documented Low BMI During Measurement Period":
      "BMI During Measurement Period" BMI
        where BMI.value < 18.5 'kg/m2'
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Low BMI Interventions Ordered":
      ( ( [ServiceRequest: "Follow Up for Below Normal BMI"]
          union [ServiceRequest: "Referrals Where Weight Assessment May Occur"]
          union [MedicationRequest: "Medications for Below Normal BMI"] ) LowInterventionsOrdered
          where LowInterventionsOrdered.reasonCode in "Underweight"
            or ( exists ( [ConditionProblemsHealthConcerns: "Underweight"]
                union [ConditionEncounterDiagnosis: "Underweight"] ) UnderweightDiagnosis
                where UnderweightDiagnosis.prevalenceInterval ( ) starts before or on day of LowInterventionsOrdered.authoredOn
                  and LowInterventionsOrdered.authoredOn during day of "Measurement Period"
            )
      )
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Low BMI Interventions Performed":
      ( [Procedure: "Follow Up for Below Normal BMI"] LowInterventionsPerformed
          where LowInterventionsPerformed.reasonCode in "Underweight"
            and LowInterventionsPerformed.status = 'completed'
            or ( exists [ConditionProblemsHealthConcerns: "Underweight"] UnderweightDiagnosis
                where ( UnderweightDiagnosis.isHealthConcern ( ) )
                  and UnderweightDiagnosis.prevalenceInterval ( ) starts before or on day of start of LowInterventionsPerformed.performed.toInterval ( )
                  and LowInterventionsPerformed.performed.toInterval ( ) during day of "Measurement Period"
                  and not ( UnderweightDiagnosis.prevalenceInterval ( ) ends before day of start of LowInterventionsPerformed.performed.toInterval ( ) )
            )
      )
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Low BMI And Follow Up Provided":
      ( "Documented Low BMI During Measurement Period" LowBMI
          with ( "Low BMI Interventions Ordered"
            union "Low BMI Interventions Performed" ) LowBMIInterventions
            such that Coalesce(LowBMIInterventions.performed.toInterval(), LowBMIInterventions.authoredOn.toInterval()) starts during day of "Measurement Period"
      )
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Has Normal BMI":
      exists ( "BMI During Measurement Period" BMI
          where BMI.value >= 18.5 'kg/m2'
            and BMI.value < 25 'kg/m2'
      )
        and not ( exists "Documented High BMI During Measurement Period"
            or exists "Documented Low BMI During Measurement Period"
        )
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Numerator":
      exists "High BMI And Follow Up Provided"
        or exists "Low BMI And Follow Up Provided"
        or "Has Normal BMI"
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Qualifying Encounter During Day Of Measurement Period":
      [Encounter: "Encounter to Evaluate BMI"] BMIEncounter
        where BMIEncounter.period during day of "Measurement Period"
          and BMIEncounter.class !~ "virtual"
          and BMIEncounter.status = 'finished'
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Initial Population":
      exists "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter
        where "AgeInYearsAt"(date from start of QualifyingEncounter.period) >= 18
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Denominator":
      "Initial Population"
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "SDE Payer":
      SDE."SDE Payer"
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "SDE Ethnicity":
      SDE."SDE Ethnicity"
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Is Pregnant During Measurement Period":
      exists ( ( [ConditionProblemsHealthConcerns: "Pregnancy or Other Related Diagnoses"]
          union [ConditionEncounterDiagnosis: "Pregnancy or Other Related Diagnoses"] ) PregnancyDiagnosis
          where PregnancyDiagnosis.prevalenceInterval ( ) overlaps day of "Measurement Period"
      )
        or exists ( [USCoreObservationPregnancyStatusProfile] PregnantObservation
            where PregnantObservation.effective.toInterval ( ) overlaps day of "Measurement Period"
              and PregnantObservation.status in { 'final', 'amended', 'corrected' }
              and ( PregnantObservation.value in "Pregnancy or Other Related Diagnoses" )
        )
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Denominator Exclusions":
      Hospice."Has Hospice Services"
        or PalliativeCare."Has Palliative Care in the Measurement Period"
        or "Is Pregnant During Measurement Period"
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "SDE Race":
      SDE."SDE Race"
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Medical Reason For Not Documenting A Follow Up Plan For Low Or High BMI":
      ( ( [ServiceNotRequested: "Referrals Where Weight Assessment May Occur"]
          union [ServiceNotRequested: "Follow Up for Above Normal BMI"]
          union [ServiceNotRequested: "Follow Up for Below Normal BMI"] ) NoBMIFollowUp
          with "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter
            such that NoBMIFollowUp.authoredOn same day as start of QualifyingEncounter.period
          where NoBMIFollowUp.status ~ 'completed'
            and NoBMIFollowUp.reasonRefused in "Medical Reason"
      )
        union ( ( [MedicationNotRequested: "Medications for Above Normal BMI"]
            union [MedicationNotRequested: "Medications for Below Normal BMI"] ) NoBMIFollowUp
            with "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter
              such that NoBMIFollowUp.authoredOn same day as start of QualifyingEncounter.period
            where NoBMIFollowUp.status ~ 'completed'
              and NoBMIFollowUp.reasonCode in "Medical Reason"
        )
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Medical Reason Or Patient Reason For Not Performing BMI Exam":
      [ObservationCancelled: "Body mass index (BMI) [Ratio]"] NoBMI
        with "Qualifying Encounter During Day Of Measurement Period" QualifyingEncounter
          such that NoBMI.effective.toInterval ( ) ends same day as start of QualifyingEncounter.period
        where ( NoBMI.notDoneReason in "Patient Declined"
            or NoBMI.notDoneReason in "Medical Reason"
        )
Logic Definition | Library Name: CMS69FHIRPCSBMIScreenAndFollowUp
    define "Denominator Exceptions":
      exists "Medical Reason For Not Documenting A Follow Up Plan For Low Or High BMI"
        or exists "Medical Reason Or Patient Reason For Not Performing BMI Exam"
Logic Definition | Library Name: QICoreCommon
    /*
    @description: Returns an interval representing the normalized prevalence period of a given Condition.
    @comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
    onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting
    interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
    */
    define fluent function prevalenceInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
    if condition.clinicalStatus ~ "active"
      or condition.clinicalStatus ~ "recurrence"
      or condition.clinicalStatus ~ "relapse" then
      Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
    else
        (end of condition.abatementInterval()) abatementDate
        return if abatementDate is null then
          Interval[start of condition.onset.toInterval(), abatementDate)
        else
          Interval[start of condition.onset.toInterval(), abatementDate]
Logic Definition | Library Name: QICoreCommon
    /*
    @description: Returns an interval representing the normalized abatement of a given Condition.
    @comment: If the abatement element of the Condition is represented as a DateTime, the result
    is an interval beginning and ending on that DateTime.
    If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
    result is an interval from the date the patient turned that age to immediately before one year later.
    If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
    which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
    before one year later than the date the patient turned the ending age of the quantity interval.
    */
    define fluent function abatementInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
    	if condition.abatement is DateTime then
    	  Interval[condition.abatement as DateTime, condition.abatement as DateTime]
    	else if condition.abatement is Quantity then
    		Interval[Patient.birthDate + (condition.abatement as Quantity),
    			Patient.birthDate + (condition.abatement as Quantity) + 1 year)
    	else if condition.abatement is Interval<Quantity> then
    	  Interval[Patient.birthDate + (condition.abatement.low as Quantity),
    		  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
    	else if condition.abatement is Interval<DateTime> then
    	  Interval[condition.abatement.low, condition.abatement.high)
    	else null as Interval<DateTime>
Logic Definition | Library Name: QICoreCommon
    /*
    @description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
    @comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
    to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
    representations for timing-valued elements in QICore, allowing this function to be used across any resource.
    The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
    The intent of this function is to provide a clear and concise mechanism to treat single
    elements that have multiple possible representations as intervals so that logic doesn't have to account
    for the variability. More complex calculations (such as medication request period or dispense period
    calculation) need specific guidance and consideration. That guidance may make use of this function, but
    the focus of this function is on single element calculations where the semantics are unambiguous.
    If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
    If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
    and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
    If the input is a DateTime Interval, the result is the input.
    If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
    is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
    immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
    If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
    */
    define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
      case
    	  when choice is DateTime then
        	Interval[choice as DateTime, choice as DateTime]
    		when choice is Interval<DateTime> then
      		choice as Interval<DateTime>
    		when choice is Quantity then
    		  Interval[Patient.birthDate + (choice as Quantity),
    			  Patient.birthDate + (choice as Quantity) + 1 year)
    		when choice is Interval<Quantity> then
    		  Interval[Patient.birthDate + (choice.low as Quantity),
    			  Patient.birthDate + (choice.high as Quantity) + 1 year)
    		when choice is Timing then
          Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
    		else
    			null as Interval<DateTime>
    	end
Logic Definition | Library Name: QICoreCommon
    /*
    @description: Returns true if the given condition is a health concern
    */
    define fluent function isHealthConcern(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
      exists (condition.category C
        where C ~ "health-concern"
      )
Logic Definition | Library Name: FHIRHelpers
    define function ToString(value uri): value.value
Logic Definition | Library Name: FHIRHelpers
    /*
    @description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
    */
    define function ToConcept(concept FHIR.CodeableConcept):
        if concept is null then
            null
        else
            System.Concept {
                codes: concept.coding C return ToCode(C),
                display: concept.text.value
            }
Logic Definition | Library Name: FHIRHelpers
    /*
    @description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
    */
    define function ToCode(coding FHIR.Coding):
        if coding is null then
            null
        else
            System.Code {
              code: coding.code.value,
              system: coding.system.value,
              version: coding.version.value,
              display: coding.display.value
            }
Logic Definition | Library Name: FHIRHelpers
    /*
    @description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
    value to a CQL DateTime Interval
    @comment: If the start value of the given period is unspecified, the starting
    boundary of the resulting interval will be open (meaning the start of the interval
    is unknown, as opposed to interpreted as the beginning of time).
    */
    define function ToInterval(period FHIR.Period):
        if period is null then
            null
        else
            if period."start" is null then
                Interval(period."start".value, period."end".value]
            else
                Interval[period."start".value, period."end".value]
Logic Definition | Library Name: Status
    define fluent function isObservationBMI(Obs List<USCoreBMIProfile>):
      Obs O
        where O.status in { 'final', 'amended', 'corrected' }
Logic Definition | Library Name: Status
    //Encounter, Performed
    //General usage unless required otherwise by measure intent (e.g., follow-up encounters)
    define fluent function isEncounterPerformed(Enc List<Encounter>):
      Enc E
        where E.status = 'finished'
Logic Definition | Library Name: Status
    //Assessment, Performed
    define fluent function isAssessmentPerformed(Obs List<ObservationScreeningAssessment>):
      Obs O
        where O.status in { 'final', 'amended', 'corrected' }
Logic Definition | Library Name: Status
    //Intervention, Order
    define fluent function isInterventionOrder(ServiceRequest List<ServiceRequest>):
      ServiceRequest S
        where S.status in { 'active', 'completed' }
          and S.intent in {'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order'}
Logic Definition | Library Name: Status
    //Intervention, Performed
    define fluent function isInterventionPerformed(Proc List<Procedure>):
      Proc P
        where P.status ~ 'completed'
Logic Definition | Library Name: Status
    //This library contains functions used to constrain FHIR resource elements for measures authored by NCQA, based on QICore 6.0.0 resources including IG and authoring patterns. The functions may appear similar to some QICoreCommon functions but differ in that they have constraints that are relevant for measures authored by NCQA.

    //Condition
    //Returns conditions in the given list that either have no verification status or have a verification status of confirmed, unconfirmed, provisional, or differential
    define fluent function verified(conditions List<Choice<ConditionProblemsHealthConcerns, ConditionEncounterDiagnosis>>):
      conditions C
        where C.verificationStatus is not null implies
          (C.verificationStatus ~ "confirmed"
            or C.verificationStatus ~ "unconfirmed"
            or C.verificationStatus ~ "provisional"
            or C.verificationStatus ~ "differential"
          )
Terminology
Code System | Description: Code system SNOMEDCT Resource: http://snomed.info/sct Canonical URL: `http://snomed.info/sct`
Code System | Description: Code system ConditionClinicalStatusCodes Resource: http://terminology.hl7.org/CodeSystem/condition-clinical Canonical URL: `http://terminology.hl7.org/CodeSystem/condition-clinical`
Code System | Description: Code system USCoreConditionCategoryExtensionCodes Resource: http://hl7.org/fhir/us/core/CodeSystem/condition-category Canonical URL: `http://hl7.org/fhir/us/core/CodeSystem/condition-category`
Code System | Description: Code system ActCode Resource: http://terminology.hl7.org/CodeSystem/v3-ActCode Canonical URL: `http://terminology.hl7.org/CodeSystem/v3-ActCode`
Code System | Description: Code system LOINC Resource: http://loinc.org Canonical URL: `http://loinc.org`
Code System | Description: Code system ConditionVerificationStatusCodes Resource: http://terminology.hl7.org/CodeSystem/condition-ver-status Canonical URL: `http://terminology.hl7.org/CodeSystem/condition-ver-status`
Value Set | Description: Value set Follow Up for Above Normal BMI Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1525 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1525`
Value Set | Description: Value set Referrals Where Weight Assessment May Occur Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1527 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1527`
Value Set | Description: Value set Medications for Above Normal BMI Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1561 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1561`
Value Set | Description: Value set Overweight or Obese Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1047.502 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1047.502`
Value Set | Description: Value set Follow Up for Below Normal BMI Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1528 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1528`
Value Set | Description: Value set Medications for Below Normal BMI Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1562 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1562`
Value Set | Description: Value set Underweight Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1563 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1563`
Value Set | Description: Value set Encounter to Evaluate BMI Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1751 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1751`
Value Set | Description: Value set Payer Type Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591`
Value Set | Description: Value set Encounter Inpatient Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307`
Value Set | Description: Value set Hospice Encounter Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003`
Value Set | Description: Value set Hospice Care Ambulatory Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584`
Value Set | Description: Value set Hospice Diagnosis Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165`
Value Set | Description: Value set Palliative Care Diagnosis Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167`
Value Set | Description: Value set Palliative Care Encounter Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090`
Value Set | Description: Value set Palliative Care Intervention Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135`
Value Set | Description: Value set Pregnancy or Other Related Diagnoses Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1623 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1623`
Value Set | Description: Value set Medical Reason Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1007`
Value Set | Description: Value set Patient Declined Resource: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1582 Canonical URL: `http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1582`
Direct Reference Code | Display: Male (finding) Code: 248153007 System: `http://snomed.info/sct`
Direct Reference Code | Display: Female (finding) Code: 248152002 System: `http://snomed.info/sct`
Direct Reference Code | Display: Active Code: active System: `http://terminology.hl7.org/CodeSystem/condition-clinical`
Direct Reference Code | Display: Recurrence Code: recurrence System: `http://terminology.hl7.org/CodeSystem/condition-clinical`
Direct Reference Code | Display: Relapse Code: relapse System: `http://terminology.hl7.org/CodeSystem/condition-clinical`
Direct Reference Code | Display: Health Concern Code: health-concern System: `http://hl7.org/fhir/us/core/CodeSystem/condition-category`
Direct Reference Code | Display: virtual Code: VR System: `http://terminology.hl7.org/CodeSystem/v3-ActCode`
Direct Reference Code | Display: Discharge to home for hospice care (procedure) Code: 428361000124107 System: `http://snomed.info/sct`
Direct Reference Code | Display: Discharge to healthcare facility for hospice care (procedure) Code: 428371000124100 System: `http://snomed.info/sct`
Direct Reference Code | Display: Hospice care [Minimum Data Set] Code: 45755-6 System: `http://loinc.org`
Direct Reference Code | Display: Yes (qualifier value) Code: 373066001 System: `http://snomed.info/sct`
Direct Reference Code | Display: confirmed Code: confirmed System: `http://terminology.hl7.org/CodeSystem/condition-ver-status`
Direct Reference Code | Display: unconfirmed Code: unconfirmed System: `http://terminology.hl7.org/CodeSystem/condition-ver-status`
Direct Reference Code | Display: provisional Code: provisional System: `http://terminology.hl7.org/CodeSystem/condition-ver-status`
Direct Reference Code | Display: differential Code: differential System: `http://terminology.hl7.org/CodeSystem/condition-ver-status`
Direct Reference Code | Display: Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal) Code: 71007-9 System: `http://loinc.org`
Direct Reference Code | Display: Body mass index (BMI) [Ratio] Code: 39156-5 System: `http://loinc.org`
Dependencies
Dependency | Description: QICore model information Resource: http://hl7.org/fhir/Library/QICore-ModelInfo Canonical URL: `http://hl7.org/fhir/Library/QICore-ModelInfo`
Dependency | Description: Library SDE Resource: https://madie.cms.gov/Library/SupplementalDataElements|5.1.000 Canonical URL: `https://madie.cms.gov/Library/SupplementalDataElements|5.1.000`
Dependency | Description: Library FHIRHelpers Resource: https://madie.cms.gov/Library/FHIRHelpers|4.4.000 Canonical URL: `https://madie.cms.gov/Library/FHIRHelpers|4.4.000`
Dependency | Description: Library Status Resource: https://madie.cms.gov/Library/Status|1.15.000 Canonical URL: `https://madie.cms.gov/Library/Status|1.15.000`
Dependency | Description: Library QICoreCommon Resource: https://madie.cms.gov/Library/QICoreCommon|4.0.000 Canonical URL: `https://madie.cms.gov/Library/QICoreCommon|4.0.000`
Dependency | Description: Library Hospice Resource: https://madie.cms.gov/Library/Hospice|6.18.000 Canonical URL: `https://madie.cms.gov/Library/Hospice|6.18.000`
Dependency | Description: Library PalliativeCare Resource: https://madie.cms.gov/Library/PalliativeCare|1.18.000 Canonical URL: `https://madie.cms.gov/Library/PalliativeCare|1.18.000`
Data Requirements
Data Requirement | Type: Patient Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient Must Support Elements: extension, birthDate, birthDate.value, url
Data Requirement | Type: Observation Profile(s): http://hl7.org/fhir/us/core/StructureDefinition/us-core-bmi Must Support Elements: value, effective, status, status.value
Data Requirement | Type: ServiceRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest Must Support Elements: code, status, status.value, intent, intent.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1525
Data Requirement | Type: ServiceRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest Must Support Elements: code, status, status.value, intent, intent.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1528
Data Requirement | Type: ServiceRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest Must Support Elements: code, status, status.value, intent, intent.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1527
Data Requirement | Type: ServiceRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest Must Support Elements: code, authoredOn, authoredOn.value, status, status.value, intent, intent.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584
Data Requirement | Type: MedicationRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest Must Support Elements: medication Code Filter(s): Path: medication ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1561
Data Requirement | Type: MedicationRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest Must Support Elements: medication Code Filter(s): Path: medication ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1562
Data Requirement | Type: MedicationRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationrequest Must Support Elements: medication.reference.value
Data Requirement | Type: Medication Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medication Must Support Elements: id.value, code
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1047.502
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1563
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-problems-health-concerns Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1623
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1047.502
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1563
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1165
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1167
Data Requirement | Type: Condition Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-condition-encounter-diagnosis Must Support Elements: code Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1623
Data Requirement | Type: Procedure Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure Must Support Elements: code, reasonCode, performed, status, status.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1525
Data Requirement | Type: Procedure Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure Must Support Elements: code, reasonCode, status, status.value, performed Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1528
Data Requirement | Type: Procedure Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure Must Support Elements: code, performed, status, status.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1584
Data Requirement | Type: Procedure Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure Must Support Elements: code, performed, status, status.value Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1135
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, hospitalization, hospitalization.dischargeDisposition, period, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.1003
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.101.12.1090
Data Requirement | Type: Encounter Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter Must Support Elements: type, period, class, status, status.value Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1751
Data Requirement | Type: Coverage Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-coverage Must Support Elements: type, period Code Filter(s): Path: type ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591
Data Requirement | Type: Observation Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment Must Support Elements: code, value, effective, status, status.value Code Filter(s): Path: code Code(s): http://loinc.org#45755-6: 'Hospice care [Minimum Data Set]'
Data Requirement | Type: Observation Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observation-screening-assessment Must Support Elements: code, effective, status, status.value Code Filter(s): Path: code Code(s): http://loinc.org#71007-9: 'Functional Assessment of Chronic Illness Therapy - Palliative Care Questionnaire (FACIT-Pal)'
Data Requirement | Type: Observation Profile(s): http://hl7.org/fhir/us/core/StructureDefinition/us-core-observation-pregnancystatus Must Support Elements: effective, effective.value, status, status.value, value
Data Requirement | Type: ServiceRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicenotrequested Must Support Elements: code, authoredOn, authoredOn.value, status, status.value, extension Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1527
Data Requirement | Type: ServiceRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicenotrequested Must Support Elements: code, authoredOn, authoredOn.value, status, status.value, extension Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1525
Data Requirement | Type: ServiceRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicenotrequested Must Support Elements: code, authoredOn, authoredOn.value, status, status.value, extension Code Filter(s): Path: code ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.600.1.1528
Data Requirement | Type: MedicationRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested Must Support Elements: medication, authoredOn, authoredOn.value, status, status.value, reasonCode Code Filter(s): Path: medication ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1561
Data Requirement | Type: MedicationRequest Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-medicationnotrequested Must Support Elements: medication, authoredOn, authoredOn.value, status, status.value, reasonCode Code Filter(s): Path: medication ValueSet: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.526.3.1562
Data Requirement | Type: Observation Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observationcancelled Must Support Elements: code, effective, extension Code Filter(s): Path: code Code(s): http://loinc.org#39156-5: 'Body mass index (BMI) [Ratio]'
Data Requirement | Type: Observation Profile(s): http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-observationcancelled Must Support Elements: code, effective, extension Code Filter(s): Path: code
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