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Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents

EHP, Priority Partners, and USFHP. Members age 3–17 years.

The percentage of members 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 year:

  • BMI* percentile (can be BMI percentile plotted on age-growth chart)
  • Counseling for physical activity
  • Counseling for nutrition
  • Services rendered during a telephone visit, e-visit or virtual check-in meet criteria for the Counseling for physical activity or Counseling for nutrition.
  • Collect height, weight and calculate BMI Percentile in medical record. All must be present and from the same medical record.

* A BMI value is not acceptable for this age range.

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

Best Practice and Measure Tips

  • Services count if the specified documentation is present, regardless of the intent of the visit, provider type or place of service.
  • BMI percentile ranges are not acceptable.

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.

Counseling Acceptable:

  • Discussion of current nutrition or physical activity behaviors (e.g., eating habits, dieting behaviors, exercise routine, participation in sports activities, exam for sports participation).
  • Checklist indicating nutrition or physical activity was addressed.
  • Counseling or referral for nutrition or physical activity.
  • Member received educational materials during a face-to-face visit.
  • Anticipatory guidance for nutrition or specific to physical activity.
  • Weight or obesity counseling.(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 AG related solely to screen time, safety (e.g. wears helmet or water safety) without specific mention of activity recommendations.
  • 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).

Measure Exclusions

Required Exclusion: Hospice

Optional Exclusions: Diagnosis of pregnancy during the measurement year.

Measure Codes

  • BMI Percentile Value Set BMI Percentile
    • ICD-10: Z68.51, Z68.52, Z68.53, Z58.54
  • Nutrition Counseling Value Set Nutrition Counseling
    • CPT: 97802, 97803, 97804
    • HCPCS: G0270, G0271, G0447, S9449, S9452, S9470
    • ICD-10: Z71.3
  • Physical Activity Counseling Value Set Physical Activity
    • HCPCS: G0447, S9451
    • ICD-10: Z02.5, Z71.82

Exclusion Codes:

  • Pregnancy Exclusion
    • ICD-10: Z34.00-Z34.03, Z34.80-Z34.83, Z34.90-Z34.93