Obesity Office Visit

RachelCoder

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Good morning! :) I just want some other coders insight on this issue. I'm a new coder and this issue is still lingering from the past 2 coders.

I have a patient who came in for an office visit. The visit basically only involved having her weight checked. The doctor didn't discuss anything else with the patient but her weight. The diagnois was obesity. The insurance denied it because her insurance doesn't pay for obesity/overweight visits. The insurance department is looking for another diagnois code to get this visit paid so the patient doesn't have to pay for it. She was in for a previous visit where insomnia and fatigue were diagnosed. Can I as the coder use those diagnosis even though they were NOT in the weight check OV, and they doctor DID NOT address those issues? I don't feel comfortable to do this and I didn't think that it was allowed if those issues were not addressed. Please help with any information you that you could give!! :)
 

mitchellde

True Blue
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No you cannot code what a visit is not just for payment . The dx code belongs to the patient and must reflect the diagnosis documented for that specific encounter. The only thing you can do is add a code for the BMI if documented. But if the payer does not cover encounters for obesity then it is patient responsibility.
 
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RachelCoder

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Thank you so much for your input. I went over and over that with the insurance lady, and I wanted to verify that I was crazy in what I was talking about!!! :)
 
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