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wartgow

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My doctor has a patient that is morbid obese. He is now starting him on a weight loss program with diet and vitamins. He is going to moniter him weekly and we were thinking that it would be ok to bill him a low level office visit for these follow up visits on his weight loss progress.
I was just curious if this is how other offices handles this situation? There might be an issue of him having an exclusion on his insurance for the diagnosis of morbid obesity so this would be a concern of charging his insurance company and it being non covered.
Thanks for any thoughts on billing for this issue.

Teresa Wartgow CPC
 
I understand your wanting to assist your patient, however if you choose to bill the insurance, you may bill only the level of service supported by your documentation. You can choose not to bill, and see the patient pro-bono, but you still have to document the care.

If the reason the patient is being seen is for treatment of his morbid obesity, then that's the diagnosis you must give. It's never a good idea to code a different diagnosis just to secure payment.

Not all payers deny claims for an obesity diagnosis, but it would make sense for you to have the patient check their benefits. Some payers recognize that if patients get their weight under control, then they are at less risk for other conditions, and they're starting to pay.
 
I work for a large group practice and many of our physicians provide weight loss treatment to their patients. When the patient is being seen for weight loss, our offices find out if the insurance will cover diagnosis code is V65.3-dietary surveillance and counselling. If they do we bill appropriate e&m code with that diagnosis code. If they do not cover we have patient sign a private pay waiver and do not bill patients insurance for service. You can still code the morbid obesity as the secondary diagnosis, however, the main reason for the visits would dietary surveillance and counselling. I have found that some insurances will not pay due to any weight loss treatment is an exclusion from plan, however, morbid obesity is a payable diagnosis but that is not the main reason for weight loss visits.



Hope this helps..
 
Be certain to add the BMI code as that will help the insurance company to understand the need for the weekly visits.
 
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