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 ID NQF # Measure Type High Priority Measure? NQS Domain Data Submission Method(s)
128 0421 Process Yes Community/Population Health Claims

Measure Description

Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter

Normal Parameters:
Age 18 years and older BMI ≥ 18.5 and < 25 kg/m2

Instructions

There is no diagnosis associated with this measure. This measure is to be submitted a minimum of once per performance period for patients seen during the performance period. This measure may be submitted by eligible clinicians who perform the quality actions described in the measure based on the services provided at the time of the qualifying visit and the measure-specific denominator coding. The BMI may be documented in the medical record of the provider or in outside medical records obtained by the provider. If the most recent documented BMI is outside of normal parameters, then a follow-up plan must be documented during the encounter or during the previous twelve months of the current encounter. The documented follow-up plan must be based on the most recent documented BMI outside of normal parameters, example: “Patient referred to nutrition counseling for BMI above or below normal parameters” (See Definitions for examples of follow-up plan treatments). If more than one BMI is submitted during the measurement period, the most recent BMI will be used to determine if the performance has been met.

NOTE: No notes for this Quality ID

Measure Submission

The listed denominator criteria is used to identify the intended patient population. The numerator quality-data codes included in this specification are used to submit the quality actions allowed by the measure. All measure-specific coding should be submitted on the claim(s) representing the eligible encounter.

Numerator

Patients with a documented BMI during the encounter or during the previous twelve months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve
months of the current encounter

Numerator Instructions:

Height and Weight – An eligible professional or their staff is required to measure both height and weight. Both height and weight must be measured within twelve months of the current encounter and may be obtained from separate encounters. Self-reported values cannot be used.

  • Follow-Up Plan – If the most recent documented BMI is outside of normal parameters, then a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter.
    The documented follow-up plan must be based on the most recent documented BMI, outside of normal parameters, example: “Patient referred to nutrition counseling for BMI above or below normal parameters”. (See Definitions for examples of follow-up plan treatments).
  • Performance Met for G8417 & G8418
    • If the provider documents a BMI and a follow-up plan at the current visit OR
    • If the patient has a documented BMI within the previous twelve months of the current encounter, the provider documents a follow-up plan at the current visit OR
    • If the patient has a documented BMI within the previous twelve months of the current encounter AND the patient has a documented follow-up plan for a BMI outside normal parameters within the previoustwelve months of the current visit

Numerator Quality-Data Coding Options

Denominator Exclusion: G8422:

BMI not Documented, Patient not Eligible

BMI not documented, documentation the patient is not eligible for BMI calculation

 

Denominator Exclusion: G8938:

BMI Documented Outside of Normal Limits, Follow-up Plan not Documented, Patient not Eligible

BMI is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible

 

Denominator Exception: G9716:

BMI Documented Outside of Normal Limits, Follow-Up Plan not Completed for Documented Reason

BMI is documented as being outside of normal limits, follow-up plan is not completed for documented reason

Performance Met: G8420:

BMI Documented as Normal, No Follow-Up Plan Required

BMI is documented within normal parameters and no follow-up plan is required

Performance Met: G8417:

BMI Documented as Above Normal Parameters, AND Follow-Up Documented

BMI is documented above normal parameters and a follow-up plan is documented

Performance Met: G8418:

BMI Documented as Below Normal Parameters, AND Follow-Up Documented

BMI is documented below normal parameters and a follow-up plan is documented

Performance Not Met: G8421:
BMI not Documented, Reason not Given

BMI not documented and no reason is given

Performance Not Met: G8419:
BMI Documented Outside of Normal Parameters, Follow-Up Plan not Documented, Reason not Given

BMI documented outside normal parameters, nofollow-up plan documented, no reason given

NUMERATOR NOTE:

Data not available

Denominator

All patients aged 18 and older on the date of the encounter with at least one eligible encounter during the measurement period

Eligible cases are determined and must be reported, if either of the following conditions

Option 1 – Denominator Criteria (Eligible Cases):

Patients aged ≥18 years on date of encounter

AND

Patient encounter during the performance period (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 96150, 96151, 96152, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99385*, 99386*, 99387*, 99395*, 99396*, 99397*, D7140, D7210, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447

WITHOUT
Telehealth Modifier:  GQ, GT, 95, POS 02

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