Pulmonology Coding Alert

Question: A pulmonologist diagnoses a patient who is to undergo treatment for obstructive sleep apnea with morbid obesity. Should I use 278.01 or 278.02?


Washington Subscriber

Answer: You should assign 278.01 for "morbid obesity," which ICD-9 guidelines define as a patient who has a body-mass index (BMI) between 30.0 and 39.9. A fifth digit of "2" identifies the patient as "overweight" with a BMI between 25 and 29.9.

Reminder: When reporting 278.01 or 278.02, you should use an additional ICD-9 code to identify the patient's BMI range. Use an adult BMI code (V85.21-V85.4) for patients 21 years of age and older. For patients 2-20 years of age, use pediatric BMI codes (V85.51-V85.54). Adult BMI is calculated based on height and weight using either of these formulas:

• Weight (kg)/[height (m)]2

• Weight (lb)/[height (in)]2 x 703.

Example: A pulmonologist diagnoses a 48-year-old obstructive sleep apnea patient as morbidly obese with a BMI of 32.0. You should report ICD-9 codes in the following order:

• Dx 1. 327.23--Obstructive sleep apnea (adult) (pediatric)

• Dx 2. 278.01--Morbid obesity

• Dx 3. V85.32--Body mass index 32.0-32.9, adult.