Coding BMI without associated DX

rmooney1114

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Hello, I need some clarification, if you will on something. As it pertains to Risk Adjustment Coding, is the coder allowed to extract just the BMI code if documented, without any associated dx also being documented, such as obesity, morbid obesity, overweight? I understand that the BMI codes are secondary codes only so they cannot be primary dx codes, but as far as reporting for risk can the BMI code be reported alone if the provider did not document anything pertaining to the patient's weight?
 

hperry10

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Good question!

Hello, I need some clarification, if you will on something. As it pertains to Risk Adjustment Coding, is the coder allowed to extract just the BMI code if documented, without any associated dx also being documented, such as obesity, morbid obesity, overweight? I understand that the BMI codes are secondary codes only so they cannot be primary dx codes, but as far as reporting for risk can the BMI code be reported alone if the provider did not document anything pertaining to the patient's weight?
I would like to know this as well. We are being instructed by an auditor to add the BMI code and the obesity code or overweight code even thought the provider makes no mention of obesity, etc. The BMI is documented and that is it. I hope a risk adjustment coder will chime in here.

Heather CPC
 

mitchellde

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In the coding guidelines it states the coder may code the BMI as long as it is captured from any person in the office such as a nurse. the diagnosis of obesity or morbid obesity however must be rendered by the provider and cannot be assume by the coder. The difference is the BMI is a number that is calculated based on as set of numbers and a proven formula. really anyone can do it and in some cases the EMR is performing the calculation. However obesity is a diagnosis and it cannot be assume given a number that is calculated out of context.
 

hperry10

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In the coding guidelines it states the coder may code the BMI as long as it is captured from any person in the office such as a nurse. the diagnosis of obesity or morbid obesity however must be rendered by the provider and cannot be assume by the coder. The difference is the BMI is a number that is calculated based on as set of numbers and a proven formula. really anyone can do it and in some cases the EMR is performing the calculation. However obesity is a diagnosis and it cannot be assume given a number that is calculated out of context.
Thank you Debra. That is what we had thought but were unsure after hearing from the auditor.
 

rmooney1114

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I am a risk adjustment coder, and I don't think the question is being understood correctly. I have spoke with several other risk coders and everyone says it depends on the project and assignment. My question is not who can document. I know that anyone can basically document the BMI, but that the provider needs to specifically documented if the patient is obese or morbidly obese. The question is, can the BMI code be reported/captured without an associated obesity code. If the provider does not document that the patient is obese, can the Z-code for the BMI still be reported. Technically BMI codes are listed as secondary codes, meaning they cannot be primary, but there is no "Code first" rule indicating that obesity needs to be coded first in order to code the BMI. Several other people on different risk adjustment forums have stated that some organization allow for just reporting the BMI regardless of any associated obesity code and others state that in order to capture the BMI code there needs to be an associated obesity code. I just wanted to see what everyone else on here thought because it is such a grey area in risk coding.
Thank you
 
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sighle

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Coding BMI without diagnosis of obesity

I am a risk adjustment coder, and I don't think the question is being understood correctly. I have spoke with several other risk coders and everyone says it depends on the project and assignment. My question is not who can document. I know that anyone can basically document the BMI, but that the provider needs to specifically documented if the patient is obese or morbidly obese. The question is, can the BMI code be reported/captured without an associated obesity code. If the provider does not document that the patient is obese, can the Z-code for the BMI still be reported. Technically BMI codes are listed as secondary codes, meaning they cannot be primary, but there is no "Code first" rule indicating that obesity needs to be coded first in order to code the BMI. Several other people on different risk adjustment forums have stated that some organization allow for just reporting the BMI regardless of any associated obesity code and others state that in order to capture the BMI code there needs to be an associated obesity code. I just wanted to see what everyone else on here thought because it is such a grey area in risk coding.
Thank you
Yes, the BMI can be coded without an accompanying obesity code. The BMI should be coded if applicable in order to have the info on the claims data for HEDIS.

To further clarify, 1. the BMI can be calculated by other health care professionals and 2. the BMI code is a secondary code but there does not need to be an associated obesity code. (think about it- the calculated BMI may not even indicate overweight but the BMI should still be coded if calculated).

I hope that answers your question.

Sighle, RN, soon to be CRC- I hope!
 

amla12

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Yes, the BMI can be coded without an accompanying obesity code. The BMI should be coded if applicable in order to have the info on the claims data for HEDIS.

To further clarify, 1. the BMI can be calculated by other health care professionals and 2. the BMI code is a secondary code but there does not need to be an associated obesity code. (think about it- the calculated BMI may not even indicate overweight but the BMI should still be coded if calculated).

I hope that answers your question.

Sighle, RN, soon to be CRC- I hope!
I'm wondering what would be the point of coding BMI as a diagnosis in a patient encounter, if it is not being addressed by the provider? In a procedure, I can see that it may be relevant, but in say a regular office visit would it be appropriate to just enter BMI without mentioning measures to address it?
 

sighle

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The point of coding BMI

I'm wondering what would be the point of coding BMI as a diagnosis in a patient encounter, if it is not being addressed by the provider? In a procedure, I can see that it may be relevant, but in say a regular office visit would it be appropriate to just enter BMI without mentioning measures to address it?
The BMI measurement is a HEDIS quality measure (NCQA) and coding it will get it onto the claims data so that it can be captured for the annual HEDIS review. Coding the BMI, if calculated, should be done even if there's no mention of measures to address it.
 

amla12

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The BMI measurement is a HEDIS quality measure (NCQA) and coding it will get it onto the claims data so that it can be captured for the annual HEDIS review. Coding the BMI, if calculated, should be done even if there's no mention of measures to address it.
Thanks for the info.
 

mamurph34

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coding BMI

Also BMI>40 does risk (HCC 22), so it is important to document it. My organization does as long as the BMI is documented in the chart, even if obesity is not discussed. We are not allowed to calculate it, even if the height/weight is in the chart-it actually has to state BMI xx.
 

kdlberg

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No, BMI can never be the first listed code. The primary diagnosis is the reason the patient is coming in for treatment. They're not coming in for treatment of their BMI. They're coming in for treatment of an associated condition. If the BMI is clinically relevant to the encounter, it should be used as an additional diagnosis.
 

TThivierge

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BMI with Risk Adjustment Coding

No, BMI can never be the first listed code. The primary diagnosis is the reason the patient is coming in for treatment. They're not coming in for treatment of their BMI. They're coming in for treatment of an associated condition. If the BMI is clinically relevant to the encounter, it should be used as an additional diagnosis.
Hi There
BMI dx code should never be first dx code. Also it is associated with RA coding however the physician needs to list a obesity or related dx code needing the BMI listed in record. Cardiac or muscle problems or DM . ..or disease which heavy weight is a no no or need to be monitored,but he or she shld mention patient 's weight monitored. Also when coding BMI dx use 2 dx codes Z68 and E66 blocks according to documentation listed which equals calculated the percentage of adipose on patient's bod ,Etc. on record.

I know some hospitals involved in meaningful use requirements and they want the BMI listed if on the patient's record(a special code put on Medicare claim) but that depends on protocol of your hospital guide from the QA and medical records department.

I hope this info helps

Lady T.
 

bburdett

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It should be noted that the guideline was updated in the 2019 ICD-CM, effective 10/1/18. It now states:

"BMI codes should only be assigned when the associated diagnosis (such as overweight or obesity) meets the definition of a reportable diagnosis (see Section III, Reporting Additional Diagnoses)."

My understanding is that the diagnosis has to be weight-specific, like obesity/overweight/underweight, not just something that would be affected by weight (which could be practically everything). And it must be an actual codeable diagnosis, not just attention to it.

From an RA perspective, it means we really need those providers to be documented morbid obesity when it's valid. But you can still get that Z68.4* with BMIs over 40 if you can find some mention in the note of the patient being at least overweight or obese.

Also, I believe there's a coding clinic that says obesity always meets the definition of a reportable diagnosis, though with overweight, you need a little more.
 
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