Wiki Obesity vs. Morbid Obesity

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jocarter

jocarter

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Good morning. I have been taught that if the BMI is above 40, but the documentation only states the patient is "obese", then we can not capture the "morbid obesity" code E66.01. I am getting push back on this and I can not find documentation to support a clear message to the provider that although the BMI may indicate that the patient is in a Morbidly Obese range, a coder can NOT assigned the morbidly obese code because that is not what is supported in the documentation. Am I completely wrong? In previous experience doing the validation audits we would not give credit for E66.01 if the record only stated "obese".

Does anyone have a good resource for this?

I appreciate any assistance on this!

Thank you!
 
Hi Jo:)
I have manual Risk Adjustment Document & Coding by author Sheri Poe,CPC CCS, CDEO, CRIC printed by AMA yr 2018 says pg. 502 that if obese dx not given but BMI% is on record/documentation you can put BMI% on claim. There are disease associated with BMI% such as dx of E43 E44 E45 E66 E68 once documented by provider. And if low weigh is by underlying condition can add BMI% for E03, B20 or Cushing syndrome. Physician should list dx Obese vs Morbid Obese, cannot add that dx. just cause got BMI over 25%.Height and other factors plus vital for provider's telling you pt. is obese or morbid obese.
Hope this data helps you.(y)
Lady T
 
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jocarter said:
Good morning. I have been taught that if the BMI is above 40, but the documentation only states the patient is "obese", then we can not capture the "morbid obesity" code E66.01. I am getting push back on this and I can not find documentation to support a clear message to the provider that although the BMI may indicate that the patient is in a Morbidly Obese range, a coder can NOT assigned the morbidly obese code because that is not what is supported in the documentation. Am I completely wrong? In previous experience doing the validation audits we would not give credit for E66.01 if the record only stated "obese".

Does anyone have a good resource for this?

I appreciate any assistance on this!

Thank you!
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I agree with how you were taught on this, and I think that the ICD-10 official guidelines are very clear on this point, in Section I.B.14 - Documentation by Clinicians Other than the Patient's Provider - (quoted below) where the guidelines outline that while a BMI code may be assigned based on documentation by staff other than the provider, the associated diagnosis must be documented by the provider. However, it is perfectly compliant to query the physician for clarification you identify that the BMI might support a different diagnosis than that which was documented.

This information is typically, or may be, documented by other clinicians involved in the care of the patient (e.g., a dietitian often documents the BMI, a nurse often documents the pressure ulcer stages, and an emergency medical technician often documents the coma scale). However, the associated diagnosis (such as overweight, obesity, acute stroke, pressure ulcer, or a condition classifiable to category F10, Alcohol related disorders) must be documented by the patient’s provider.
 
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