HFS Issues New Directive on Pediatric Weight Management

Posted on: December 4, 2013

On October 3, 2013, the Department of Healthcare and Family Services (HFS) issued a new directive on pediatric weight management documentation and claims coding. The directive, BMI Assessment and Obesity-related Weight Management Follow-up among Children and Adolescents: Documentation and Claims Coding Instructions, was published in a provider informational notice and is posted on the HFS website (a PDF can be downloaded here).

HFS states that the purpose of the notice is twofold. First, the notice is to advise providers about the requirement to assess and document BMI percentile at least once per year. Provider documentation of BMI percentile classification is linked to HFS annual performance reporting to the Centers for Medicare and Medicaid Services. HFS reports on the prevalence of weight assessment of children and adolescents documented through claims as one of a core set of child health measures. Second, the notice is intended to clarify the circumstances under which weight management evaluation and management (E&M) visits can be billed.

The informational notice is directed to the following health care providers: physicians, advanced practice nurses, federally qualified health centers, encounter rate clinics, hospitals, local education agencies, local health departments, and school-based/linked health centers. ICAAP’s Committee on Obesity will be developing physician education about the new policy in the coming months. For further information, please contact Mary Elsner, Director, Obesity Prevention Initiatives, at melsner@illinoisaap.com or 312/733-1026, ext 220.