General Surgery Coding Alert

Don't confuse 'other' with 'unspecified.'

Although coding morbid obesity won't tell the whole "medical necessity" story for lap-band procedures (see "Don't Count on Obesity for Medical Necessity,"General Surgery Coding Alert Vol. 14, No. 8), you'll need to know how to report the condition once ICD-10 is implemented.

The latest: CMS has finalized the ICD-10 implementation date for Oct. 1, 2014, as stated in the Sept. 5 Federal Register. The announcement ended months of speculation that began in April when CMS proposed delaying the original Oct. 1, 2013 implementation date.

Distinguish Additional Obesity Data

You'll find a direct crosswalk from ICD-9 (278.01, Morbid obesity) to ICD-10 (E66.01, Morbid [severe] obesity due to excess calories). But you can see that ICD-10 provides some additional clinical information about the condition's cause.

You should look for physician documentation about caloric intake to help distinguish E66.01 from other obesity causes such as the following:

• E66.1 -- Drug-induced obesity (which doesn't have an ICD-9 counterpart)
• E66.2 -- Morbid (severe) obesity with alveolar hypoventilation (which parallels ICD-9 code 278.03, Obesity hypoventilation syndrome).

Look for 'Other' Code

If your physician doesn't provide specific information about the patient's obesity, you have an "unspecified" code in both ICD-9 (278.00, Obesity, unspecified) and ICD-10 (E66.9, Obesity, unspecified).

But if your physician provides diagnostic information that doesn't fit any specific code, you'll have a way to report it in ICD-10 that you don't have in ICD-9: E66.8 (Other obesity).