Wiki BMI V-codes

[andrealrussell]

When using a V-code for BMI (V85.41 for example) is it necessary to also code the 278.01 for morbid obesity? The only information I can find says that the V-code cannot be the primary diagnosis, but nothing about the obesity code being mandatory.

Thanks in advance for the help.
Andrea Russell

 

[Terri Reynolds]

278.XX & V Codes

Good Morning:
278.01 would be Prime and the V... is second.
( However, some Plans do not allow Obesity Codes as a Prime,
so it is best to check with the Plan involved ).

 

[andrealrussell]

What if the BMI is the only thing documented in the record? Obesity/Morbid Obesity are not documented anywhere, just BMI = 42.1.

 

[mitchellde]

if the BMI is all that is documented then I cannot see how you will be able to bill the claim. Can you send the note back to the provider for additional info?
The guidelines are clear that the BMI may be documented by any clinic qualified person , yet only the provider may document the level of obesity, and they do need to match, if not the provider gets to decide what must be changed.

 

[andrealrussell]

Sorry, I should have been more clear in my post. The record is for a diabetes check (coded correctly). The argument we are having is related to the BMI code (V85.41) and if it can be coded without documentation of morbid obesity (278.01).

 

[mitchellde]

There is no instruction in the book that the BMI must associate with certain specific codes, so as long as it is secondary you should be fine.

 

[andrealrussell]

Thank you for your help, that is what I thought.

 

[cordelia]

Agree with Debra, there is no guideline stating that you must also code an obesity code. And since the physician did not state Obesity/Morbid obesity, it would be an assumption to code it, which as we all know, assumptions are not allowed. Not documented- not done.


Cordelia, DRG Auditor, CCS, CPC