Question Bariatric Consult- Sequencing of ICD10 Codes


Best answers
I have a patient who presented for an E/M conducted via telemedicine services. I'm second-guessing myself on all the Dx the physician addressed, so I'd like some feedback on the best sequencing. I welcome any feedback on the CPT portion as well if you have any. I have posted the Complete Assessment below, as well as what the previous coder inputted and what I believe should be inputted, and they are in the order I think they should be sequenced. The biggest one that throws me is the T2DM Dx because I'm unsure of its effect on the obesity Dx, and I cannot find any articles/guidelines that relate the two regarding ICD10.

The previous coder's input:
98968, 95
E66.01, G47.33, J44.9, E11.9, K21.9, I27.20, Z99.81

My Input:
99214, 95
E66.01, E11.9*, K21.9, G47.33, Z68.41, J44.9, I27.23

I removed the Z99.81 because it says "previously on CPAP", I moved J44.9 to the end because while the medication was addressed in relation to the bariatric surgery, I don't feel that it had precedence over the other codes directly related to the E66.01, and I also changed I27.20 to I27.23 because pulmonary hypertension correlates to COPD.

Assessment & Plan
Type 2 diabetes mellitus 250.00 | E11.9
Current Plans:
OSA (obstructive sleep apnea) 327.23 | G47.33
Current Plans:
Obesity, morbid, BMI 40.0-49.9 278.01 | E66.01

Today's Impression: BMI 41 associated with GERD on omeprazole, OSA previously on CPAP, type 2 DM on Truilicity, and
moderate pulmonary HTN on Lasix. She no longer eats sweets or drink carbonation. She stopped using edible cannabis last
month. She had COVID and was hospitalized for 10 days, and now recovering well. She lost 20 pounds because of COVID.
She does have stage 4 COPD and will need lung transplant in the future. She requires prednisone whenever she develops
pneumonia or has difficulty breathing. We discussed risks and benefits of sleeve gastrectomy vs gastric bypass vs duodenal
switch. Because of ongoing need for oral steroids, I think sleeve gastrectomy may be her best option. I do believe patient
can be a good candidate for weight loss surgery and will start work up.

This visit was conducted utilizing good-faith telemedicine services via two-way synchronous audio and visual communication.
The patient identity was verified and verbal consent was given to proceed with a virtual visit.

Current Plans:
How to Access Health Information Online using Patient Portal and 3rd Party Apps
cc: Primary Care Provider
Follow up after tests have been performed.
Make appointment for follow-up office visit after appointment with specialist.
COPD (chronic obstructive pulmonary disease) 496 | J44.9
Current Plans:
Moderate pulmonary hypertension 416.8 | I27.20
Current Plans:
GERD (gastroesophageal reflux disease) 530.81 | K21.9
Current Plans:

-End of Assessment/Plan - I would really appreciate some knowledge on sequencing. I understand that we code first the reason for the encounter/principal Dx, but it gets a little confusing at times when the physician addresses other Dx that aren't directly related to the reason for the consult. I get that everything addressed does impact the consult, but the sequencing can be difficult for me.

Thanks in advance for any help! =)

-Raveena S.