miriambroyles
Contributor
Hello,
Should CDI coders consider a dx of morbid obesity clinically supported/audit compliant if the BMI has fallen below 35 with GLP1 use? I understand morbid obesity can be coded if the provider diagnoses it regardless of BMI, coders are not to interpret BMI, and that payors will even accept the diagnosis. My question is will morbid obesity be considered clinically supported and audit-compliant by CMS standards in these situations with objective evidence of a BMI now below 35? Or does the simple fact that a weight-related condition is being controlled with GLP1 make morbid obesity forever supported regardless of current BMI? My inclination would be to query the provider to confirm their diagnosis considering resolution of the severity of obesity with GLP1 treatment, but I'm looking for industry opinion to back such a query.
Should CDI coders consider a dx of morbid obesity clinically supported/audit compliant if the BMI has fallen below 35 with GLP1 use? I understand morbid obesity can be coded if the provider diagnoses it regardless of BMI, coders are not to interpret BMI, and that payors will even accept the diagnosis. My question is will morbid obesity be considered clinically supported and audit-compliant by CMS standards in these situations with objective evidence of a BMI now below 35? Or does the simple fact that a weight-related condition is being controlled with GLP1 make morbid obesity forever supported regardless of current BMI? My inclination would be to query the provider to confirm their diagnosis considering resolution of the severity of obesity with GLP1 treatment, but I'm looking for industry opinion to back such a query.