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Pediatric BMI for HEDIS coding

  1. #1
    Question Pediatric BMI for HEDIS coding
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    Our clinic just started coding BMI for every encounter as applicable for HEDIS standards. Our staff uses adult BMI calculations for all age groups. The pediatric BMI codes are for patients under 21. We have been using the measurements taken by staff to convert these erroneous adult BMIs into Pediatric percentiles so that we may apply the correct code.

    My questions are:
    Are we allowed to do this?
    Will the staff need to start using Pediatric calculations for all patients under 21?
    What about Asian BMI calculations?

    From what I have researched, it seems we aren't supposed to calculate BMI ourselves, even if the height/weight/ age are there.

    All insight is appreciated, thanks!

  2. #2
    For BMI, the code assignment may be based on medical record documentation from clinicians who are not the patient’s provider. The key word here is “clinicians.” Their documentation is allowed because they are involved in the care of the patient (ex: dietitian, nurses, etc). However, the associated diagnosis (such as overweight or obesity) must be documented by the patient’s provider.

    So if the clinicians are calculating these incorrectly at an Adult rate and not a Pediatric rate, this needs to be corrected at the point of entry by the clinician. A coder should not be recalculating for coding purposes. The same would hold true if the BMI needed to be calculated based on race/ethnicity.
    Chelle Johnson, CPC CPMA CDEO CEMC CPCO CPPM AAPC Fellow
    Billing/Coding/Credentialing/Auditing Coordinator

    20+ years experience in Medical Billing and Auditing

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