Weight assessment and counseling in children/adolescents (WCC)

We are committed to working with you to improve the quality of care and health outcomes for our members, your patients. The Healthcare Effectiveness Data and Information Set (HEDIS®) is one tool we use to measure many aspects of performance. The information below details some of the key features of the HEDIS measure for weight assessment and counseling in children/adolescents.

What is the measure?

The measure assesses the percentage of members ages 3-17 who had an outpatient/office visit with a primary caregiver or OB/GYN, and who had evidence of the following during the measurement year:

• Body measure index (BMI) percentile*
• Counseling for nutrition
• Counseling for physical activity

*BMI percentile as a value or plotted on an age-growth chart. The height, weight, and BMI must be from the same chart, but can be on a different date of service during the measurement year.  

Acceptable documentation

• Encounter form, diagnostic report, progress notes, office note, problem list, and Subjective, Objective, Assessment Plan (SOAP) note.

Compliant determination for BMI percentile

Determination documentation must include height, weight, and BMI percentile during the measurement year. The height, weight, and BMI percentile must be from the same data source. Either of the following meets criteria for BMI percentile:

• BMI percentile documented as a value (e.g., 85th percentile). Documentation of >99% or

<1% meet criteria because a distinct BMI percentile is evident (i.e., 100% or 0%), BMI percentile plotted on an age-growth chart.

Documentation: Examples NOT compliant for BMI percentile

• No BMI percentile documented in medical record or plotted on age-growth chart
• Notation of BMI value only
• Notation of height and weight only
• Ranges and thresholds
• Self-reported by the member

Compliant determination for nutrition counseling

Documentation must include a note indicating the date and at least one of the following:

• Discussion of nutrition behaviors
• Completed checklist specific to nutrition
• Counseling or referral specific to nutrition
• Member received educational materials/handouts specific to nutrition during office visit
• Anticipatory guidance specific to nutrition
• Weight or obesity or eating disorders counseling

Non-compliant documentation: Examples for nutrition counseling

• Discussion or counseling on nutrition specific to an acute or chronic condition
• Counseling/education before or after the measurement year
• Anticipatory guidance or health education without specific mention of nutrition   
• A physical exam without mention of nutritional counseling

Compliant determination for physical activity counseling

Documentation must include a note indicating the date and at least one of the following:

• Discussion of current physical activity behaviors
• Checklist specific to physical activity
• Counseling or referral specific to physical activity
• Member received educational materials specific to physical activity during an office visit
• Anticipatory guidance specific to physical activity
• Weight or obesity or eating disorders counseling

Non-compliant documentation: Examples for physical activity counseling

• Discussion or counseling on physical activity specific to an acute or chronic condition  
• Counseling/education before or after the measurement year
• Medically cleared for gym activities without mention of physical activity
• Anticipatory guidance or health education without mention of physical activity
• Anticipatory guidance related to safety practices without mention of physical activity recommendations
• Computer or television screen time limitations without mention of physical activity

Exclusions

• Members who received a diagnosis of pregnancy (Pregnancy Value Set) during the measurement year
• Members who received hospice care during the measurement year

Medical codes

BMI:

            ICD-10: Z68.51, Z68.52, Z68.53, Z68.54

Nutrition:

            CPT: 97802, 97803, 97804

            HCPCS: G0270, G0271, G0447, S9449, S9452, S9470

            ICD-10: Z71.3

Physical activity:

            HCPCS: G0447, S9451

            ICD-10: Z02.5, Z71.82