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New specifications for BMI screening

There is debate about the effectiveness of the Body Mass Index (BMI). It doesn’t take into account many different characteristics of an individual. But there is general concurrence that BMI is a quick way to determine whether additional screening for obesity and obesity linked conditions should take place.

That’s why BMI calculation is still part of the Healthcare Effectiveness Data and Information Set (HEDIS®), the quality measurement tool developed by the National Committee for Quality Assurance (NCQA) and used by 90 percent of U.S. health plans, including CareOregon.

It’s also part of the CareOregon medical record review process. We encourage providers to calculate BMI at least annually and document it for each patient 18–74 years of age who has an outpatient visit.

Over the last couple of years, NCQA has modified the specifications for recording and reporting BMI, so CareOregon’s annual review has been changed, too. Here is what we—and NCQA—are looking for:

  • The medical record must indicate weight and BMI value for the patient, as recorded during the year or year before the measurement is taken.  The weight and BMI must be from the same data source.
  • For members younger than 19 years on the date of service, the following documentation of BMI percentile also must meet this criteria:
    • BMI percentile documented as a value (e.g. “85th percentile”)
    • BMI percentile plotted on an age-growth chart
  • Use the ICD-9 code V85.0-V85.5 after obtaining weight and calculating BMI. Using these codes may decrease the number of chart reviews that are required during the collection of HEDIS data.
  • Notation of height and weight alone is not satisfactory. The BMI calculation must be completed and included in the record.

CareOregon would like to partner with you to ensure that your BMI work is being counted. Please email if your clinic would be interested in learning some key aspect of this specific HEDIS measure or needs administrative aids and guidance and resources.

*HEDIS® is a registered trademark of the National Committee for Quality Assurance.