• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Will CMS consider morbid obesity dx supported if on GLP1 but BMI is decreasing?

M

miriambroyles

Networker
Messages
37
Location
Fort Worth, TX
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.
 
As per my experience in a few projects in my experience of 1.5 years in HCC risk adjustment, we can consider it as a complication of pregnancy and if the provider mentioned it to be a complication then we can consider it as complication only as it is also leading directly, in Pregnancy>>>complicated by>>>Obesity-- we can code directly. Hope it was helpful in your case. I do not have any idea how coders follow this in CDI though.
Click to expand...
 
You must log in or register to reply here.
Top