ADULT BMI ASSESSMENT

Transcription

1 ADULT BMI ASSESSMENT APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included? STANDARD OF CARE NCQA ACCEPTED CODES DOCUMENTATION REQUIREMENTS What documentation should be submitted? HEDIS (Hybrid) Healthy Kentuckians NCQA Accreditation NCQA Rating To identify members whose body mass index (BMI) or BMI percentile was documented at an outpatient visit during the measurement year or year prior Adult members age 18 of January 1st of the year prior to the measurement year to age 74 as of December 31st of the measurement year. Members with a diagnosis of pregnancy during the measurement year or year prior are excluded from the measure. BMI should be assessed at least annually. Please see code table. HEDIS Requirements: For members 21 years and older on the DOS: Weight and BMI value dated during the measurement year or year prior. For members less than 21 years old on DOS: Height, weight, and BMI percentile or BMI percentile plotted on an age-growth chart documented during the measurement year or year prior. Healthy Kentuckians: In addition to the aforementioned HEDIS requirements, Healthy Kentuckians looks for all adult members heights to be documented at any time in the medical record. Screening for tobacco use and cessation counseling if identified as tobacco user during the two-year measurement period. Also, assessment and/or counseling related to nutrition and physical

2 activity should be documented during the measurement year or year prior. The medical record may contain one or more of the following related to nutrition: o Notations of current nutrition level (eating habits, special diets, fast food intake, fat/carbohydrate intake, etc.) o Checklist indicating nutrition was addressed. o Counseling or referral for nutrition education. o Member received education materials on nutrition during a face to face visit (must be documented with date). o Anticipatory guidance for nutrition (for members < 19 years of age). o Weight or obesity counseling. The medical record may contain one or more of the following related to physical activity: o Discussion of current physical activity behaviors (e.g., exercise routine, participation in sports activities.) o Checklist indicating physical activity was addressed. o Counseling or referral for physical activity. o Member received educational materials on physical activity during a face to face visit. o Anticipatory guidance for physical activity (for members <19 years of age). o Weight or obesity counseling. The Medical record documentation of screening for tobacco use must include the date and specific notation that may include: o Checklist with specific entry for tobacco use/smoking assessment. o Checklist or note regarding current or past tobacco use. o Medical record form with completed check box for the tobacco use

3 screening. o Medical record notes that indicate positive or negative tobacco use. o Completed screening tool with tobacco use addressed (e.g., the NM-ASSIST [NIDA-Modified Alcohol, Smoking, and Substance Involvement Screening Test]). o Medical record notes regarding current tobacco use, counseling for tobacco use, or prescribing smoking cessation medication. o Notation of counseling or treatment referral for tobacco cessation. o Notation or copy of a prescription for smoking cessation medication prescribed for tobacco cessation (see Appendix 1 for a medication list) o Notation of conducting the 5 A s meets the numerator requirements for screening for tobacco use, positive tobacco use, and intervention for tobacco use. The 5 A s are: Ask about tobacco use, Advise patient to quit, Assess willingness to make a quit attempt, Assist in the quit attempt, and arrange follow-up. REFERENCES Preventive Health and Cardiovascular Clinical Practice Guideline. The criteria above are based on standards established under NCQA s HEDIS 2016 Technical Specifications. HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). Appendix 1 Nicotine Patch i.e. (Habitrol patch) Nicotine Lozenge i.e. (Good Sense) Nicotine Gum i.e. (Nicorette) Nicotine Nasal Spray i.e. (Nicotrol NS) Bupropion i.e. (Zyban) Varenicline (i.e. Champix, Chantix)

4 Nicotine Inhaler Other Medications specifically prescribed for smoking cessation ie. Catapress-TTS, clonidine, Topiragen, Topiramate, Topamax, Topamax Sprinkle, tryptophan, carbonic anhydrase, naltrexone, nortriptyline

5 ADULT BMI ASSESSMENT Meet Screening Criteria For members 21 years of age or older: ICD10CM Z68.1 [Z68.1] Body mass index (BMI) 19 or less, adult ICD10CM Z68.20 [Z68.20] Body mass index (BMI) , adult ICD10CM Z68.21 [Z68.21] Body mass index (BMI) , adult ICD10CM Z68.22 [Z68.22] Body mass index (BMI) , adult ICD10CM Z68.23 [Z68.23] Body mass index (BMI) , adult ICD10CM Z68.24 [Z68.24] Body mass index (BMI) , adult ICD10CM Z68.25 [Z68.25] Body mass index (BMI) , adult ICD10CM Z68.26 [Z68.26] Body mass index (BMI) , adult ICD10CM Z68.27 [Z68.27] Body mass index (BMI) , adult ICD10CM Z68.28 [Z68.28] Body mass index (BMI) , adult ICD10CM Z68.29 [Z68.29] Body mass index (BMI) , adult ICD10CM Z68.30 [Z68.30] Body mass index (BMI) , adult ICD10CM Z68.31 [Z68.31] Body mass index (BMI) , adult ICD10CM Z68.32 [Z68.32] Body mass index (BMI) , adult ICD10CM Z68.33 [Z68.33] Body mass index (BMI) , adult ICD10CM Z68.34 [Z68.34] Body mass index (BMI) , adult ICD10CM Z68.35 [Z68.35] Body mass index (BMI) , adult ICD10CM Z68.36 [Z68.36] Body mass index (BMI) , adult ICD10CM Z68.37 [Z68.37] Body mass index (BMI) , adult ICD10CM Z68.38 [Z68.38] Body mass index (BMI) , adult ICD10CM Z68.39 [Z68.39] Body mass index (BMI) , adult ICD10CM Z68.41 [Z68.41] Body mass index (BMI) , adult ICD10CM Z68.42 [Z68.42] Body mass index (BMI) , adult ICD10CM Z68.43 [Z68.43] Body mass index (BMI) , adult ICD10CM Z68.44 [Z68.44] Body mass index (BMI) , adult ICD10CM Z68.45 [Z68.45] Body mass index (BMI) 70 or greater, adult ICD9CM V85.0 BMI less than 19,adult ICD9CM V85.1 BMI between 19-24,adult ICD9CM V85.21 BMI ,adult ICD9CM V85.22 BMI ,adult ICD9CM V85.23 BMI ,adult ICD9CM V85.24 BMI ,adult ICD9CM V85.25 BMI ,adult ICD9CM V85.30 BMI ,adult

6 ICD9CM V85.31 BMI ,adult ICD9CM V85.32 BMI ,adult ICD9CM V85.33 BMI ,adult ICD9CM V85.34 BMI ,adult ICD9CM V85.35 BMI ,adult ICD9CM V85.36 BMI ,adult ICD9CM V85.37 BMI ,adult ICD9CM V85.38 BMI ,adult ICD9CM V85.39 BMI ,adult ICD9CM V85.41 BMI , adult ICD9CM V85.42 BMI , adult ICD9CM V85.43 BMI , adult ICD9CM V85.44 BMI , adult ICD9CM V85.45 BMI 70 and over, adult For members younger than 21 years of age: ICD10CM Z68.51 [Z68.51] Body mass index (BMI) pediatric, less than 5th percentile for age ICD10CM Z68.52 [Z68.52] Body mass index (BMI) pediatric, 5th percentile to less than 85th percentile for age ICD10CM Z68.53 [Z68.53] Body mass index (BMI) pediatric, 85th percentile to less than 95th percentile for age ICD10CM Z68.54 [Z68.54] Body mass index (BMI) pediatric, greater than or equal to 95th percentile for age ICD9CM V85.51 BMI,pediatric <5% ICD9CM V85.52 BMI,pediatric 5% - <85% ICD9CM V85.53 BMI,pediatric 85% - <95% ICD9CM V85.54 BMI,pediatric >= 95% Counseling for Nutrition (Healthy Kentuckians) CPT CPT CPT HCPCS G0270 Medical nutrition therapy; reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition or treatment regimen (including additional hours needed for renal disease), individual, face to face w HCPCS G0271 Medical nutrition therapy, reassessment and subsequent intervention(s) following second referral in same year for change in diagnosis, medical condition, or treatment regimen (including additional hours needed for renal disease), group (2 or more individu HCPCS G0447 Face-to-face behavioral counseling for obesity, 15 minutes (G0447) HCPCS S9449 Weight management classes, non-physician provider, per session (S9449)

7 HCPCS S9452 Nutrition classes, non-physician provider, per session (S9452) HCPCS S9470 Nutritional counseling, dietitian visit (S9470) ICD10CM Z71.3 [Z71.3] Dietary counseling and surveillance ICD9CM V65.3 Dietary surveillance and counseling Counseling for Physical Activity (Healthy Kentuckians) HCPCS G0447 Face-to-face behavioral counseling for obesity, 15 minutes (G0447) HCPCS S9451 Exercise classes, non-physician provider, per session (S9451) ICD9CM V65.41 Exercise counseling Pregnancy Exclusions