Product Lines:
EHP, Priority Partners, and USFHP.

Eligible Population:
Member 3–17 years as of December 31 of the measurement year.

Definition:
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

Report two age stratifications and a total for each of the three indicators:

• 3–11 years.
• 12–17 years.
• Total. *The total is the sum of the age stratifications.

Continuous Enrollment:

• The measurement year.

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.
• 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:

• 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).

Measure Exclusions

Required Exclusion:

• Members in hospice or using hospice services anytime during the measurement year. 
• Members who have a diagnosis of pregnancy any time during the measurement year. 
• Members who died any time during the measurement year.

Exclusion Codes:

• Pregnancy Exclusion
• ICD-10-CM: Z34.00-Z34.03, Z34.80-Z34.83, Z34.90-Z34.93
  • Note: Not all Pregnancy Value Set codes are listed. 

Measure Codes

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