Wiki CMS-HCC 22 Reporting Guidelines


Crystal Lake, IL
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Hello Everyone, I have my AAPC CRC certification and in the course material for BMI and Morbid Obesity, it documents the following: "the diagnoses of morbid obesity is only coded when documented as such by the treating provider and never assumed. Without the documentation of morbid obesity, the coder can only assign the proper code for the annotated BMI reading when present." The 2017 ICD-10-CM guidelines states that the BMI reading should only be reported as a secondary code.

My interpretation from the CRC course material and experience in Medicare Risk Adjustment; if the BMI reading is documented it can be reported for risk adjustment. The physician must document morbid obesity to report the diagnosis. Both diagnoses are assigned HCC 22. My manager is following the ICD-10 guidelines and stating that the BMI cannot be reported without documentation supporting morbid obesity, because BMI is a secondary diagnosis. Doesn't this apply to billing and not Medicare Risk Adjustment?

I would greatly appreciate it if someone could clarify the reporting of BMI and morbid obesity for Medicare Risk Adjustment.

Thank you
Sharyn P-C, BS, MLT, CPC, CRC
Your interpretation is correct!

I agree with the CRC material and YOU! The provider does need to document obesity in order to code the BMI status code, as it is a secondary diagnosis code. It does not, however, have to be documented as "morbid" obesity. If they state the patient is obese or morbidly obese, that is enough support to code the BMI status code.
Coding BMI & Obesity

Just adding to your question about diagnosis coding BMI. BMI is coded no matter if the physician states any type of obesity, being overweight, etc. If there is documentation in the patients records showing a BMI, this should be coded. The physician needs to state obesity, overweight, etc. in order to code this. Hope this helps.
Cheryl W. BS, CPC, CRC