General Surgery Coding Alert

Presented by Jan Rasmssen, CPC, ACS-GI, ACS-OB

Bariatric surgery, gastric restrictive procedures, bypass procedures are performed to control the amount of food intake and/or nutrient absorption to promote weight loss in the morbidly obese.  When you get started one of the first things that you need to do is pre-certification.  Part of that is understanding the definition of overweight versus obesity. 

Overweight or obesity is determined by the BMI--body mass index--which is a ratio-based calculation of weight and height.  Obviously, the higher the body mass indeed, the greater the risk of lung diseases, high blood pressure, coronary artery disease, stroke, osteoarthritis, cancer, and type II diabetes.  Morbidly obese people have trouble with their joints and their lower extremities--hip, pelvis, knees and that type of things.  So obesity is an increased risk for additional problems. 

-Overweight- signifies an excess body weight when compared to established standards.  The next issue is who establishes the standards?  There are a lot of people who would like to establish standards.  Those standards have changed throughout the years.  It really is a terminology that is somewhat negotiable.  The overweight person him or herself is not an obese person.  BMI range for overweight individuals is typically 25-30 kg weight ratio.  Now this weight can be derived from muscle, bone, fat, body water and that type of things and one example from some of my resources is where they are saying a bodybuilder or a professional athlete may be technically considered overweight due to increased muscle mass, but that does not mean that they are obese. 

Obesity refers specifically to excess body weight that stands from an abnormally high percentage of body fat.  The bone structure and muscle mass would not play a role in determining obesity.  There has been a long debate about the cut-off for obesity through the years.  The American Hospital Association defines obesity as -body weight 30% greater than the ideal body weight.-  You can find probably 3-4 different charts for ideal body weight and they vary by 5-6 pounds, but not very much.  Others consider the threshold to be 25% body fat for men and 35% body fat for women, however, there is an agreed upon range that is usually agreed upon by most Federal agencies and medical societies, and that is the body mass of 30 kg or greater.  So that is the body mass index that is most generally agreed upon.

Morbid obesity is the basis for gastric restrictive bypass or bariatric surgery.  By the way, we do have a specific code for morbid obesity and that is 278.01.  278.00 is obesity unspecified.  Next year in October we are getting a new code--278.02--for just an overweight person.  So you are going to probably need the morbid [...]