Wiki HCC Question: Severe obesity vs Class II obesity with comorbidities

[grown113]

I have a HCC coding question about Class II obesity with comorbidities. The patient has a BMI of 38.23 with comorbidities of hypertension and DM. Documentation states patient is obese and recommends patient to lose weight by exercise. SnoMed stated Class II obesity with severe comorbidities is not E66.01 but E66.9. Where can I find tangible information that severe is Class II? There a lot of references saying different things. Can the documentation state serious instead of severe? Also if the BMI is 38.23 and the physician documents Morbid obesity instead of Severe obesity with comorbidities, is that sufficient?

Please help

 

[JRPayne]

1. If Morbid Obesity is documented in the PMH, Problem, chronic, current list, the BMI must be 40 or higher to be able to code the E66.01.
2. If the Morbid Obesity is documented anywhere else in the note that is not the PMH, Problem, chronic, current list, E66.01 can be coded if the documented BMI is 35 or higher.
3. If the BMI is not documented, and Morbid Obesity is documented anywhere else in the note that is not the PMH, Problem, chronic, current list, E66.01 can be coded.

Just remember-Obesity (E66.9) does not risk adjust and anything below Z68.35 does not risk adjust. Also, remember, you are the coder and you can only code what the Provider documents, no exceptions. If it is not documented it never happened.

Hope this helps, this is how I was advised.
Janice Randall-Payne BS, CPC-I, COC, CPC, CCS-P, PCS, CPAR
AHIMA-Approved ICD-10-CM/PCS Trainer