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Obesity dx code

MsMaddy

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232
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We seem to be having problem with the insurance not covering the patient's
visit for obesity as primary dx code. Can anyone tell me what other dx code
can be used instead of obesity. There are times where the Dr has two dx in his dictation obesity is dicated as the primary and then the other 2ndary dx code. I know we can't use the 2ndary code as primary and make the obesity as 2ndary since dictation shows obesity as primary. But can I have the
Dr to change his dication to show the obesity dx as 2ndary even though the
pt first complain was obesity? Please help this is an issue.


Thank you all in advance
 
Messages
155
Location
Albany, NY
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Obesity

What insurance is this for? And are you using 278.00 or 278.01? Medicare will not pay for either as a primary code--they require a complication/co-morbidity as the PDX (such as HTN, DJD, Hyperlipidemia).

If you look in the Tabular List of your ICD-9, you'll see 278.00 is "grayed out" which means unacceptable PDX. Try being more specific--278.01 or 278.02 depending on BMI.
 
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4,466
Location
Milwaukee WI
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Doctors documentation

The doctor's documentation may not necessarily list diagnosis in the proper sequence as per ICD-9 conventions. Few physicians are certified coders.

So even though the doctor's note states obesity as primary, and XXX (let's say hypertension) as secondary, that doesn't mean you can't code the XXX as your primary dx. ICD-9 clearly notes (because it is highlighted in color) that 278.00 and 278.01 cannot be used as primary.

Also, remember that the patient's complaint is not the same as the physician's diagnosis. The patient might complain of "obesity;" the doctor may diagnosis "hypertension."

I would also take the opportunity to educate your physician about the preferred sequencing of Dx, and how it can effect his reimbursement.

F Tessa Bartels, CPC
 

Jackie Stack

Networker
Messages
52
Location
Oil City, PA
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You need to check the patient's benefits. Some insurance plans just don't cover obesity no matter which obesity dx code you use. When I use an obesity dx I also use a vcode for the BMI. More insurance plans are starting to cover this dx.
 
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