Wiki Coding for BMI in an AWV record

Community Wiki

This is a community-maintained wiki post containing the most important information from this thread. You may edit the Wiki once you have been on AAPC for 30 days and have made 5 posts. Learn More

drksingh

Contributor
Messages
14
Best answers
0
Hello Coding experts,

I have a question on the coding for BMI from an AWV. IF the provider does not address the BMI or the diagnosis of overweight, obesity, or morbid obesity, can the coder code for the Z code for the BMI ?
As per coding clinic guideline 2018; 4th qtr., coders are not allowed to code for secondary like BMI if the diagnosis is not mentioned in the document. Now does AWV have a different rule we can follow, or simply we cant code for BMI without the primary diagnosis?

Looking for closure on a debate. Please feel free to elaborate on a scenario where we can code for BMI without the provider giving the primary reason to code for BMI.
 

thomas7331

True Blue
Messages
3,303
Best answers
10
I'm not aware of any exceptions to coding guidelines that apply specifically to AWV and cannot think of a scenario that would warrant adding the BMI code if the related disease was not documented, unless it was a particular payer or contractor requirement that you've been requested to follow.

As you've correctly noted, ICD-10 guidelines specify that BMI should only be coded in conjunction with the associated diagnosis. Since the AWV is a preventive service and not a diagnostic or therapeutic service directed at the treatment of a particular disease or condition, there would be no reason to code the BMI, and I've never seen any direction from CMS to the contrary. Hope that helps some.
 

drksingh

Contributor
Messages
14
Best answers
0
Thank you @thomas7331
Another thing I found that is helpful is that the IPPE doesn't require any ICD-10 code to come on a claim. So I guess for that loophole every code will fly through.
 
Last edited:

thomas7331

True Blue
Messages
3,303
Best answers
10
Thank you @thomas7331
Another thing I found that is helpful is that the IPPE/AWV doesn't require any ICD-10 code to come on a claim. So I guess for that loophole every code will fly through.
Yes, but keep in mind that these are two different issues - which codes will allow a claim to be paid is a matter of payer reimbursement policy and payer system configuration; which diagnosis codes most accurately report the medical record is a question of correct coding guidelines.
 
Top