Pediatric Coding Alert

Question: Can the same equation that providers use for calculating adult body mass index (BMI) — weight in pounds x 703 divided by height in inches — be used to determine BMI for a child?

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Answer: No. While adult BMI is calculated using a standard height-to-weight formula, pediatric BMI is based on how a child’s measurements compare with their peers of the same age and sex.

For instance, a typical BMI for a 3-year-old male would be different than for a 5-year-old female, even if the BMI number itself ends up being the same. A helpful tool to have on hand is the Child and Teen BMI Calculator by the Centers for Disease Control and Prevention (CDC), which incorporates the relevant percentile information.

Make note: BMI values are unavailable for children under 2 years of age using this calculator.

A few new E codes have Use additional code instructions directing you to explore new childhood Z codes for better treatment options. In pediatrics, obesity is now classified into three classes based on BMI percentiles, which is reflected by the Z codes. Here are some of the codes:

• E66.811 (Obesity, class 1)
• E66.812 (Obesity, class 2)
• E66.813 (Obesity, class 3)
• Z68.54 (Body mass index [BMI] pediatric, 95th percentile for age to less than 120% of the 95th percentile for age)
• Z68.55 (Body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age)
• Z68.56 (Body mass index [BMI] pediatric, greater than or equal to 140% of the 95th percentile for age)

These classifications help guide the intensity of treatment and intervention needed.

For obesity code claim submission, code category E66.- (Overweight and Obesity) first, then use an additional code category Z68.- (Body Mass Index [BMI]) for children 2-19 years old.

Lindsey Bush, BA, MA, CPC, Production Editor, AAPC