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Body Mass Index (BMI) Assessment: Children and Adolescents Tip Sheet
The percentage of members 3-17 years of age who had an outpatient visit with a primary care provider (PCP) or OB/GYN and who had a body mass index (BMI) percentile documented during the measurement year.
Incentives will be paid on an annual basis, following the end of Quarter 4. For additional information, refer to the CBI Technical Specifications.
- Members in hospice or using hospice services anytime during the measurement year.
- Female members who have a diagnosis of pregnancy during the measurement year.
For members 3-17 years on the date of service, use one of the following BMI percentile codes to ensure compliance for this measure. Members meet the requirements if they have had one of the following diagnosis (ICD-10) codes billed:
- Z68.51 – BMI pediatric, less than 5th percentile for age.
- Z68.52 – BMI pediatric, 5th percentile to less than 85th percentile for age.
- Z68.53 – BMI pediatric, 85th percentile to less than 95th percentile for age.
- Z68.54 – BMI pediatric, greater than or equal to 95th percentile for age.
Data for this measure will be collected using claims, DHCS Fee-for-Service encounter claims, and provider data submissions via the Data Submission Tool (DST) on the Portal del Proveedor. To find gaps in data:
- Run a report from your electronic health record (EHR) system; or.
- Manually compile patient data (Example: Download your monthly BMI Assessment: Children and Adolescents quality report or quarterly Care-Based Incentives Measure Details report on the Provider Portal and compare to your EHR/paper charts).
This measure allows providers to submit BMI percentile codes to the Alliance from the clinic EHR system or paper records by the DST contractual deadline. To submit, you may upload data files to the DST on the Portal del Proveedor. To be accepted, data must be submitted as a CSV file. Step-by-step instructions are available in the Data Submission Tool Guide on the Portal del Proveedor.
- Take advantage of every office visit to discuss health lifestyle habits, including nutrition and physical activity.
- Enroll members 2-18 years of age who are at or above the 85th CBI percentile into the Alliance’s Healthy Weight for Life program using the Health Education and Disease Management Programs Referral Form. This health education program works with the parents/guardians and their children to teach healthy eating and lifestyle changes for families. Members will also be entered in a raffle to receive a gift card or a new bike. Learn more on our Health Education and Disease Management Programs page.
- Medical Nutritional Therapy provided by a Registered Dietitian is a covered benefit for members that meet qualifying conditions. More information can be found in the Medical Nutrition Therapy Benefit Quick Information Guide.
- Ensure members are getting an adequate amount of sleep.
- Monitor the Provider Portal reports to identify members that are missing documentation of BMI assessment.
- Make sure your EHR lists the BMI percentile, not just the value. If not, contact your EHR vendor and ask them to make changes so that the percentile is available for every member.
- Set up ICD-10 codes in your EMR protocols so that the provider is prompted to use them when applicable.
- Alliance interpreting services are available to network providers:
- Telephonic interpreting services are available to assist in scheduling members.
- Face-to-face interpreters can be requested to be at the appointment with the member.
For information about our Cultural and Linguistic Services Program, please call the Alliance Health Education Line at 800-700-3874, ext. 5580 or email us at [email protected].
- Refer patients who have transportation challenges to the Alliance’s Transportation Coordinator at 800-700-3874, ext. 5577. This service is not covered for non-medical locations or for appointments that are not medically necessary.
- Promoting Health Weight from Bright Futures.