M e a s u r i i n g f f o r B M I I
For children and adolescents 3 to 17 years of age, HEDIS ® is measuring weight assessment and counseling for nutrition and physical activity for children/adolescents. Because BMI norms vary, this measure evaluates whether BMI percentile is assessed. Health plans are mandated to review charts if there is no billing code to indicate that the assessment and counseling have been done. If you want to reduce the number of medical chart reviews, please make sure you include the following codes:
Note: A code for each of the three services must be used to meet this HEDIS ®
Description
BMI percentile
Counseling for nutrition
Counseling for physical activity
CPT
97802-
97804
ICD-9-CM Diagnosis
V85.51 <5 th
V85.52 5 th
V85.53
V85.54
V65.3
85
percentile
- <85 th - <95
≥95 th th percentile th percentile
percentile
V65.41
ICD-9-
CM
93.11,
93.13,
93.19,
93.31
HCPCS
S9470,
S9452,
S9449,
G0270-
G0271
S9451
measure.
Documentation must include a note indicating the date and one from each of the three boxes below
• BMI percentile or
• BMI percentile plotted on age-growth chart
• Discussion of current nutrition behaviors or
• Checklist indicating nutrition was addressed or
• Counseling or referral for nutrition education or
• Member received educational materials on nutrition or
• Anticipatory guidance for nutrition
• Discussion of current physical activity behaviors or
• Checklist indicating physical activity was addressed or
• Counseling or referral for physical activity or
• Member received educational materials on physical activity or
• Anticipatory guidance for physical activity
The CDC has an online tool for BMI percentile measurement available at https://apps.nccd.cdc.gov/dnpabmi .
For adults 18 to 74 years of age: HEDIS ® is looking at members who had an outpatient visit and had their body mass index (BMI) documented at least once every two years.
Documentation in the medical record must indicate the date of the BMI and the BMI value. For members younger than 19 years, documentation of BMI as a percentile and/or plotted on an age-growth chart would also be accepted.
ICD-9-CM
Diagnosis
V85.0 to V85.5
The NIH provides an adult BMI calculator at http://www.nhlbisupport.com/bmi and a table at http://www.nhlbi.nih.gov/guidelines/obesity/bmi_tbl.htm
.
Assess and document the following at a well or sick visit:
1.
Patient height and weight
2.
Calculated BMI or BMI percentile
3.
Counseling for nutrition and physical activity for children/adolescents
4.
Include BMI/counseling codes when billing to reduce need for medical record review