Wiki Obesity dx help

[june616]

Pt came in to f/u and get refill for his weight loss medication. No other issues discussed at appt. Billed 278.00 (obesity, simple) with 99213 and claim denied "service not covered with procedure." Should this have been billed differently? I am ready to bill to pt as non-covered charges but I want to make sure it's not a coding error first before I do that. Thank you!!

 

[alysn1drlnd]

Obesity is a non-covered dx for some insurance carriers, is there no other dx you can pull from the chart to put as the primary dx code?

 

[mitchellde]

Obesity is a non-covered dx for some insurance carriers, is there no other dx you can pull from the chart to put as the primary dx code?

You should never "hunt" for a different dx code just for reimbursement the visit was for the obesity and that is what the primary code must be.. I can only suggest adding a BMI code as some payers have indicated they will pay for obesity encounters if the BMi code is included. Also if this is Medicare you need to use the G codes for obesity counseling and follow the timeframes for the encounters as well as the required documentation and Medicare will pay these with no pt responsible amount.

 

[k.keller]

The other consideration is the 278.00 Unspecified code. The insurance company may be looking for a Morbid Obesity or Overweight specified diagnosis code (278.01- 278.02) instead of this vague 278.00 code. Having said that, most plans do not have coverage for obesity counseling or dietary counseling.

Lastly, have you considered changing the 99213 E/M to a specific nutritional therapy code 97802-97804?

 

[Andreka1]

If the patient only came in for a medication refill the dx should be V68.1

 

[hunters]

This same thread falls in line with one of mine on obesity coding with co-morbidities. I'm having the same problem with claims being denied when only the 278.01 and BMI are billed. But the physician does give co-morbidity dx's at the bottom of her note such as HTN or sleep apnea; however, nowhere else in the entire note are these co-morbidities mentioned, discussed, evaluated or treated. So I don't know if I can code the co-morbidities or not. If I were to code the co-morbidities, the insurances would pay. My thought process is even if my physician is not the one "treating" the co-morbidites, he/she at least has to address them (i.e. who is treating them, what meds are they taking, what is the current status, etc.) in order to code them as well as the obesity. Any thoughts??