Wiki E66.01 Criteria

[eharloff]

Hello!

I have a question/concern regarding E66.01 listed on some of our patients HCC lists that our ACO gives us for our Medicare Advantage patients. This code is sometimes listed for patients with comorbidities but their BMI is less than 35 - I have always been under the impression that E66.01 would not be used unless the patient with comorbidities has a BMI greater than or equal to 35 or a patient without comorbidities has a BMI greater than or equal to 40.

Now maybe when E66.01 was listed the patient's weight was at or above 35 and we have to report it to get it off the list, but if patient doesn't meet the criteria, why would I report that code on the claim if it's inaccurate?

 

[nickelclaw]

we code what is there we aren't clinicians and there is no I10 guidelines on E66 other than code also BMI when available. There is a coding clinic 2ndQ 2022 that states class there is E66.01 and if documented class 1 or 2 to query for more specific diagnostic code.

 

[eharloff]

we code what is there we aren't clinicians and there is no I10 guidelines on E66 other than code also BMI when available. There is a coding clinic 2ndQ 2022 that states class there is E66.01 and if documented class 1 or 2 to query for more specific diagnostic code

You're right - I guess I read into it too much and forget ICD-10 doesn't state anything regarding that. Thanks!

 

[TThivierge]

Eharloff
If use E66 dx code use the additional code of Z68 per % of BMI listed in record. It is one of the dx codes which need additional dx code.
I hope this data helps you
Lady T