ADULT BMI ASSESSMENT
APPLICATIONS
HEDIS (Hybrid)
Healthy Kentuckians
NCQA Accreditation
NCQA Rating
Kyhealthnow 2019 goal*
OBJECTIVE
To identify members whose body mass index
Purpose of Measure:
(BMI) or BMI percentile was documented at an
outpatient visit during the measurement year or
year prior
ELIGIBLE POPULATION
Adult members age 18 of January 1st of the
Which members are included? year prior to the measurement year to age 74
as of December 31st of the measurement year.
STANDARD OF CARE
NCQA ACCEPTED CODES
DOCUMENTATION
REQUIREMENTS
What documentation should
be submitted?
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. Also,
assessment and/or counseling related to
nutrition and physical 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.
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).
* Governor Steve Beshear has made improving the health and wellness of
Kentucky’s children, families and workforce one of his highest priorities. To
significantly advance the wellbeing of Kentucky’s citizens, Governor Beshear
announced several health goals for the Commonwealth in February 2014. He
outlined a number of strategies to help achieve these goals over the next five
years, and will continue to add strategies throughout his term. These strategies
will be implemented through executive and legislative actions, public-private
partnerships and through the success of enrolling Kentuckians in health care
coverage.
ADULT BMI ASSESSMENT
Meet Screening Criteria
For members 21 years of age or older:
Code System
Code
Definition
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD10CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
Z68.1
Z68.20
Z68.21
Z68.22
Z68.23
Z68.24
Z68.25
Z68.26
Z68.27
Z68.28
Z68.29
Z68.30
Z68.31
Z68.32
Z68.33
Z68.34
Z68.35
Z68.36
Z68.37
Z68.38
Z68.39
Z68.41
Z68.42
Z68.43
Z68.44
Z68.45
V85.0
V85.1
V85.21
V85.22
V85.23
V85.24
V85.25
V85.30
[Z68.1] Body mass index (BMI) 19 or less, adult
[Z68.20] Body mass index (BMI) 20.0-20.9, adult
[Z68.21] Body mass index (BMI) 21.0-21.9, adult
[Z68.22] Body mass index (BMI) 22.0-22.9, adult
[Z68.23] Body mass index (BMI) 23.0-23.9, adult
[Z68.24] Body mass index (BMI) 24.0-24.9, adult
[Z68.25] Body mass index (BMI) 25.0-25.9, adult
[Z68.26] Body mass index (BMI) 26.0-26.9, adult
[Z68.27] Body mass index (BMI) 27.0-27.9, adult
[Z68.28] Body mass index (BMI) 28.0-28.9, adult
[Z68.29] Body mass index (BMI) 29.0-29.9, adult
[Z68.30] Body mass index (BMI) 30.0-30.9, adult
[Z68.31] Body mass index (BMI) 31.0-31.9, adult
[Z68.32] Body mass index (BMI) 32.0-32.9, adult
[Z68.33] Body mass index (BMI) 33.0-33.9, adult
[Z68.34] Body mass index (BMI) 34.0-34.9, adult
[Z68.35] Body mass index (BMI) 35.0-35.9, adult
[Z68.36] Body mass index (BMI) 36.0-36.9, adult
[Z68.37] Body mass index (BMI) 37.0-37.9, adult
[Z68.38] Body mass index (BMI) 38.0-38.9, adult
[Z68.39] Body mass index (BMI) 39.0-39.9, adult
[Z68.41] Body mass index (BMI) 40.0-44.9, adult
[Z68.42] Body mass index (BMI) 45.0-49.9, adult
[Z68.43] Body mass index (BMI) 50-59.9 , adult
[Z68.44] Body mass index (BMI) 60.0-69.9, adult
[Z68.45] Body mass index (BMI) 70 or greater, adult
Body Mass Index less than 19, adult
Body Mass Index between 19-24, adult
Body Mass Index 25.0-25.9, adult
Body Mass Index 26.0-26.9, adult
Body Mass Index 27.0-27.9, adult
Body Mass Index 28.0-28.9, adult
Body Mass Index 29.0-29.9, adult
Body Mass Index 30.0-30.9, adult
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
ICD9CM
V85.31
V85.32
V85.33
V85.34
V85.35
V85.36
V85.37
V85.38
V85.39
V85.41
V85.42
V85.43
V85.44
V85.45
Body Mass Index 31.0-31.9, adult
Body Mass Index 32.0-32.9, adult
Body Mass Index 33.0-33.9, adult
Body Mass Index 34.0-34.9, adult
Body Mass Index 35.0-35.9, adult
Body Mass Index 36.0-36.9, adult
Body Mass Index 37.0-37.9, adult
Body Mass Index 38.0-38.9, adult
Body Mass Index 39.0-39.9, adult
Body Mass Index 40.0-44.9, adult
Body Mass Index 45.0-49.9, adult
Body Mass Index 50.0-59.9, adult
Body Mass Index 60.0-69.9, adult
Body Mass Index 70 and over, adult
For members younger than 21 years of age:
Code System
Code
Definition
ICD10CM
ICD10CM
Z68.51
Z68.52
ICD10CM
Z68.53
ICD10CM
Z68.54
ICD9CM
ICD9CM
ICD9CM
ICD9CM
V85.51
V85.52
V85.53
V85.54
[Z68.51] Body mass index (BMI) pediatric, less than 5th percentile for age
[Z68.52] Body mass index (BMI) pediatric, 5th percentile to less than 85th
percentile for age
[Z68.53] Body mass index (BMI) pediatric, 85th percentile to less than 95th
percentile for age
[Z68.54] Body mass index (BMI) pediatric, greater than or equal to 95th
percentile for age
Body Mass Index, pediatric, less than 5th percentile for age
Body Mass Index, pediatric, 5th percentile to less than 85th percentile for age
Body Mass Index, pediatric, 85th percentile to less than 95th percentile for age
Body Mass Index, pediatric, greater than or equal to 95th percentile for age
Counseling for Nutrition (Healthy Kentuckians)
Code System
Code
Definition
CPT
CPT
CPT
HCPCS
97802
97803
97804
G0270
HCPCS
G0271
HCPCS
HCPCS
G0447
S9449
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
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
Face-to-face behavioral counseling for obesity, 15 minutes (G0447)
Weight management classes, non-physician provider, per session (S9449)
HCPCS
HCPCS
ICD10CM
ICD9CM
S9452
S9470
Z71.3
V65.3
Nutrition classes, non-physician provider, per session (S9452)
Nutritional counseling, dietitian visit (S9470)
[Z71.3] Dietary counseling and surveillance
Dietary surveillance and counseling
Counseling for Physical Activity (Healthy Kentuckians)
Code System
Code
Definition
HCPCS
HCPCS
ICD9CM
Pregnancy
G0447
S9451
V65.41
Face-to-face behavioral counseling for obesity, 15 minutes (G0447)
Exercise classes, non-physician provider, per session (S9451)
Exercise counseling
Exclusions