Wiki Morbid obesity coding

[siddharthaqa@rediffmail.com]

BMI more than 40 is mentioned in vital signs under the heading physical exam section.

Can we code E66.01 (morbid obesity) or it must be documented in the report by the provider to capture it? E66.01 has an HCC value.

Thanks in advance for any help/advice.

 

[sls314]

The provider has to diagnose morbid obesity (or "severe obesity") to use E66.01.

Coders cannot interpret BMI or test results and turn them into a diagnosis. It has to be stated by the provider.

The Z68.4- codes have an HCC value as well. I would check to confirm whether your project rules allow you to add the appropriate BMI over 40 code, even if you can't add the E66.01

 

[sls314]

BMI is one of diagnosis codes allowed to be added by staff other than the provider. Perhaps the provider can be queried to add the morbid obesity code if it was related to the visit.

If they weren't seen for obesity and it is not relevant to the visit, then neither BMI nor obesity should be added.

I think the poster works in risk adjustment if I recall correctly from some of his other questions. It's probably unlikely that he can query the provider.

There are some retrospective risk adjustment data validation projects where it wouldn't matter if the BMI was discussed in the visit - you'd still be expected to add the appropriate Z code if the BMI was in the chart. It really depends on the rules of the specific project.

 

[thranowski]

I think the poster works in risk adjustment if I recall correctly from some of his other questions. It's probably unlikely that he can query the provider.

There are some retrospective risk adjustment data validation projects where it wouldn't matter if the BMI was discussed in the visit - you'd still be expected to add the appropriate Z code if the BMI was in the chart. It really depends on the rules of the specific project.

Oh, I see. I was of the mind that they were billing for an office or something like that.

Ha, I didn't pay attention to what topic I was in. Says Risk Adjustment. So sorry!

 

[siddharthaqa@rediffmail.com]

The 2019 ICD-10-CM Official Guidelines state that you cannot use a BMI code alone (these are found in ICD-10-CM code category Z68.-). BMI codes should only be assigned when the associated diagnosis (such as for overweight or obesity) meets the definition of a reportable diagnosis.

Can we use BMI codes as standalone codes? I think they are always meant to be accompanied by a corresponding diagnosis code.

we are working for Medicare insurance only (risk-adjustment), outpatient, no project-specific guideline given.

 

[second to none]

Yes, I agree with Siddharthaqa. There is a coding clinic article which published in 2018. we cannot code BMI as a stand alone if there is no supportive diagnosis in the note. The provider has to document obesity or other chronic condition that related to BMI in order to code Z68 categories codes. before 2018 we used to code BMI without supported diagnosis

 

[Pathos]

Yup you got it!

This Coding Clinic echoes what you and Siddharthaqa said:

AHA CODING CLINIC

Volume 5 – Number 4 Fourth Quarter 2018

Updates

Body Mass Index ​

Question:

Is there a list of diagnosis codes that are associated with the body mass index (BMI) measurement codes? Can BMI codes be assigned without a corresponding documented diagnosis of overweight, obesity or morbid obesity from the provider?

Answer:

No, the provider must provide documentation of a clinical condition, such as overweight, obesity or morbid obesity, to justify reporting a code for the body mass index. As stated in the Official Guidelines for Coding and Reporting, Section I.B.14, the associated diagnosis (such as overweight or obesity) must be documented by the patient’s provider. If the linkage between the BMI and a clinical condition is not clearly documented, query the provider for clarification. ICD-10-CM does not provide definitions or a list of diagnosis codes associated with BMI.