Product Lines:
EHP, Priority Partners, and USFHP.

Measurement Period: January 1 - December 31
 
Description:
The percentage of persons 3–17 years of age who had an outpatient visit with a PCP or OB/GYN and who had evidence of the following during the measurement period:

• BMI* percentile (can be BMI percentile plotted on age-growth chart)
• Counseling for physical activity
• Counseling for nutrition

Because BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed rather than an absolute BMI value.

Provider Specialty: PCP or OB/GYN

Stratifications: 
Age as of the last day of the measurement period.

• 3-11 years.
• 12-17 years.

Measure Reporting:
HealthChoice Performance Measure reporting for Priority Partners. 

Improvement Notation:
Increased score indicates improvement.

Data Collection:

• Administrative.
• Hybrid.
• Supplemental.

Initial Population:

• Measure Item Count: Person.
• Age: 3–17 years of age as of the last day of the measurement period.
• Benefits: Medical.
• Continuous Enrollment: The measurement period.
• Allowable gap: No more than one gap of ≤45 days during the measurement period. No gaps on the last day of the measurement period.

Definition:
BMI percentile: The percentile ranking based on the CDC’s BMI-for-age growth charts, which indicates the relative position of a person’s BMI number among others of the same gender and age.

Denominator:
An outpatient visit (Outpatient Value Set) with a PCP or an OB/GYN during the measurement period.

Numerator:
Numerator 1: BMI percentile.
Persons with BMI percentile assessed during the measurement period.

Numerator 2: Counseling for nutrition.
Persons who received counseling for nutrition during the measurement period.

Numerator 3: Counseling for physical activity.
Persons who received counseling for physical activity during the measurement period.

 

Best Practice and Measure Tips

• Services count if the specified documentation is present, regardless of the intent of the visit or place of service.
• Services rendered during a telephone visit, e-visit or virtual check-in meet criteria for the Counseling for physical activity or Counseling for nutrition.  
• BMI norms for youth vary with age and gender, this measure evaluates whether BMI percentile is assessed rather than an absolute BMI value.

BMI Percentile Acceptable Documentation:

• BMI percentile plotted on an age-growth chart or documented as a value (50th percentile).
• Member-collected height, weight, and BMI percentile if entered into medical record.

BMI Percentile Not Acceptable Documentation:

• BMI percentile ranges are not acceptable.
• No BMI percentile documented in medical record or plotted on age-growth chart.
• Notation of BMI value only.
• Notation of height and weight only.

Counseling Acceptable:

• The measure age starts at 3.  Documentation for the younger age groups often does not mention physical activity or the documentation does not meet requirements.  Be sure to include physical activity counseling for all ages in measure and the documentation clearly states counseling or anticipatory given for nutrition and physical activity.   
• Discussion of current nutrition or physical activity behaviors (e.g., eating habits, dieting behaviors, “Patient has an adequate or well-balanced diet”, exercise routine, participation in sports activities, exam for sports participation, “Patient gets an adequate amount of exercise.”, “Lack of physical activity” (if not related to acute or chronic condition).
• Checklist indicating nutrition or physical activity was addressed.
• Counseling or referral for nutrition or physical activity.
• Member received educational materials for nutrition and physical activity during a face-to-face visit. 
• Anticipatory guidance for nutrition or specific to physical activity.
• Weight or obesity counseling (eating disorders). Services rendered for obesity or eating disorders meets criteria for both counseling
• Referral to WIC.

Counseling Not Acceptable:

• Physical Exam finding or observation alone (e.g., well-nourished) or developmental milestones alone (e.g., Does not throw a ball).
• Notation of a discussion without specific mention of nutrition or physical activity (e.g., "appetite", "healthy lifestyle habits", "Limits T.V,/computer time", "Cleared for gym class").
• Notation of a discussion without specific mention of nutrition or physical activity (e.g., "appetite", "healthy lifestyle habits", "Limits T.V., computer time", "Cleared for gym class").
• Assessment of an acute or chronic condition (e.g., presents with chronic foot pain - unable to run, presents with diarrhea, received instructions for BRAT diet). Capture information during sick visits clearly. Documenting “Anticipatory Guidance provided for nutrition and physical activity” is acceptable. This will provide counseling specifically for the measure and ensure it is not related to the assessment or treatment of an acute or chronic condition.

Measure Exclusions

Denominator Exclusions:

• Persons in hospice or using hospice services any time during the measurement period. 
• Persons who have a diagnosis of pregnancy any time during the measurement period. 
• Persons who died any time during the measurement period.

Exclusion Codes

Pregnancy Exclusion

• ICD-10-CM Maternal conditions: O00-O99*
• ICD-10-CM Encounter: O9A.111, O9A.112, O9A.113, O9A.119, O9A.12, O9A.211, O9A.212, O9A.213, O9A.219, O9A.22, O9A.311, O9A.312, O9A.313, O9A.319, O9A.32, O9A.411, O9A.412, O9A.413, O9A.419, O9A.42, O9A, Z03.71, O9AZ03.71, Z03.72, Z03.73, Z03.74, Z03.75, Z03.79, Z33.1, Z33.2, Z33.3, Z34.00, Z34.01, Z34.02, Z34.03, Z34.80, Z34.81, Z34.82, Z34.83, Z34.90, Z34.91, Z34.92, Z34.93, Z36.0, Z36.1, Z36.2, Z36.3, Z36.4, Z36.5, Z36.81, Z36.82, Z36.83, Z36.84, Z36.85, Z36.86, Z36.87, Z36.88, Z36.89, Z36.8A, Z36.9
• SNOMED CT US: 199305006, 199050003, 10750801000119102, 703309000, 300571009, 366323009, 428567001, 428930004, 429715006, 313180007, 428566005, 313178001, 428058009, 433601000124106, 441924001, 417570003, 11687002, 75022004, 46894009, 40801000119106, 10753491000119101, 237285000, 199141002, 77376005, 34165000, 724485008, 300573007, 300572002, 416402001, 609516006, 609519004, 86081009, 27152008, 87621000, 33370009, 1142097006, 80224003, 1142048002, 10751701000119102, 472699005*

*Please note that not all ICD-10-CM and SNOMED CT US Edition codes are listed here. For access to the complete set of codes related to Pregnancy Value Set, contact your Provider Engagement Liaison or email [email protected].

Measure Codes

BMI Percentile 

• ICD-10-CM: Z68.51, Z68.52, Z68.53, Z68.54, Z68.55, Z68.56
• LOINC: 59574-4, 59575-1, 59576-9

Nutrition Counseling 

• CPT: 97802, 97803, 97804
• HCPCS: G0270, G0271, G0447, S9449, S9452, S9470
• ICD-10-CM: Z71.3
• SNOMED CT US Edition: 11816003, 61310001, 183059007, 183060002, 183061003, 183062005, 183063000, 183065007, 183066008, 183067004, 183070000, 183071001, 226067002, 266724001, 275919002, 281085002, 284352003, 305849009, 305850009, 305851008, 306163007, 306164001, 306165000, 306626002, 306627006, 306628001, 313210009, 370847001, 386464006, 404923009, 408910007, 410171007, 410177006, 410200000, 429095004, 431482008, 443288003, 609104008, 698471002, 699827002, 699829004, 699830009, 699849008, 700154005, 700258004, 705060005, 710881000, 1230141004, 14051000175103, 428461000124101, 428691000124107, 441041000124100, 441201000124108, 441231000124100, 441241000124105, 441251000124107, 441261000124109, 441271000124102, 441281000124104, 441291000124101, 441301000124100, 441311000124102, 441321000124105, 441331000124108, 441341000124103, 441351000124101, 445291000124103, 445301000124102, 445331000124105, 445641000124105

Physical Activity Counseling 

• HCPCS: G0447, S9451
• ICD-10-CM: Z02.5, Z71.82
• SNOMED CT US Edition: 103736005, 183073003, 281090004, 304507003, 304549008, 304558001, 310882002, 386291006, 386292004, 386463000, 390864007, 390893007, 398636004, 398752005, 408289007, 410200000, 410289001, 410335001, 429778002, 710849009, 435551000124105