MACRA Monday: BMI screening and follow-up


If you haven’t started reporting quality data for the Merit-Based Incentive Payment System (MIPS), there’s still time to avoid a 4% cut to your Medicare payments.

Under the Pick Your Pace approach being offered this year, the Centers for Medicare & Medicaid Services allows clinicians to test the system by reporting on one quality measure for one patient through paper-based claims. Be sure to append a Quality Data Code (QDC) to the claim form for care provided up to Dec. 31, 2017, in order to avoid a penalty in payment year 2019.

Consider this measure:

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Measure #128: Preventive Care and Screening: Body Mass Index Screening and Follow-Up Plan

This measure is aimed at capturing the percentage of patients aged 18 years and older who have had their body mass index (BMI) calculated and documented in the last 6 months and a follow-up plan developed if the BMI was too high or too low.

What you need to do: Assess the patient’s BMI during the visit or document that it was done in the last 6 months. Patient-reported height and weight values cannot be used. If the BMI is outside of normal parameters (18.5 kg/m2 to 25 kg/m2), develop a follow-up plan or document that one was made in the last 6 months.

Eligible cases include patients who were aged 18 years or older on the date of the encounter and a patient encounter during the performance period. Applicable codes include (CPT or HCPCS): 90791, 90792, 90832, 90834, 90837, 96150, 96151, 96152, 97161, 97162, 97163, 97165, 97166, 97167, 97802, 97803, 98960, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, D7140, D7210, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447 without telehealth modifiers GQ or GT.

To get credit under MIPS, be sure to include a QDC that shows that you successfully performed the measure or had a good reason for not doing so. For instance, G8420 indicates that BMI has been documented within normal parameters and no follow-up plan is required, while G8417 and G8418 indicate BMI above and below normal parameters, respectively, with a documented follow-up plan.

Use exclusion code G8938 if the BMI has been documented as being outside of normal limits, but a follow-up plan is not documented because the patient is not eligible. For example, patients are considered not eligible if they are 65 years or older and weight reduction or gain would complicate an underlying health condition.

CMS has a full list measures available for claims-based reporting at The American Medical Association has also created a step-by-step guide for reporting on one quality measure.

Certain clinicians are exempt from reporting and do not face a penalty under MIPS:

  • Those who enrolled in Medicare for the first time during a performance period.
  • Those who have Medicare Part B allowed charges of $30,000 or less.
  • Those who have 100 or fewer Medicare Part B patients.
  • Those who are significantly participating in an Advanced Alternative Payment Model (APM).

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