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Any Bariatric Coders Out There?

  1. #11
    Default Obesity diagnosis coding - help !!
    Medical Coding Books
    Can we list/code the co-morbidities following the obesity code and the BMI code - even if the physician doesn't assess or treat the comorbidities? The comorbidities (such as HTN or Vit D deficiency) are mentioned only as "pt as history of xxxxx, xxxxx" in the HPI, but thats it. Then those comorbidities - and sometimes additional ones that weren't even mentioned in the HPI - are listed in the diagnosis list as "comment only". So my question is whether or not I should/can list all these comorbidities in addition to the obesity diagnosis. The patients are only coming in for weight management/obesity counseling and sometimes to follow up on metabolic labs. If I don't list comorbidities, insurances are denying the claims with just the obesity and BMI diagnosis.

  2. #12

  3. #13
    Default
    Hey Hunters, I am new to Bariatric as well & I add the co-morbities as well if the patient has had it. Normally if a patient has Diabetes or Hypertension, it really does not go away immediatly you know what I mean? I had trouble latly with our surgeries getting denied for just morbid obesity, have you run into that yet with Medicare?

  4. #14
    Location
    Fort Worth Texas
    Posts
    100
    Default
    The comorbidities must be on the claim to support the medical need for the surgery. That is what our local carriers require. Carriers have specific bariatric policies which you can find online.
    Michelle Cook,CPC, CPCO, CPMA, CEMC, CGSC, CPEDC,
    2017 AAPC MACRA Proficient

  5. #15
    Default Obesity diagnosis coding - help !!
    Yes....in the beginning I was having surgeries come back denied because I wasn't listing the co-morbidities. I have since found the "Bariatric Surgery for Morbid Obesity" NCD and CMS policy for Bariatric Surgery. But this only gave me the coding guidance I needed for surgeries. Fortunately, my surgeons are very good about listing all the co-morbidities in their op note. My main problem is the office visit for "weight management counseling". Some insurances will cover only an obesity dx - but many will not. Even though the pt's may truly have say HTN and sleep apnea as co-morbities, my concern is that the physicians are not addressing, evaluating, or treating them and barely (if at all) documenting them in the office note. Here is a sample HPI.

    65 yr old female presents for weight mnmgt f/u. Weight: 274 today. last weight unchanged. pt has decreased bodyfat mass by 2 pounds and increased muscle mass by 2 pounds. pt states diet is going well. adhering strictly. water intake good. sleep good. pt states she is complaint with vitamins. no new medical issues. pt has been using stair stepper for exercise and plans to invest in a recumbant bike.

    You'll notice not a single co-morbity is mentioned - however, in the assessment/diagnosis list, I'm given the following dx's to bill: 278.01, V85.41, 401.9, 268.9. No where in the entire note is the HTN and Vit D Def addressed. SO.....do I bill the co-morbidities with a note that looks like this....or are the physicians required to document something about the co-morbities? I'm thinking they at least have to state the status...what meds are they taking, what were the last lab results, who is treating it, etc.

  6. Default Bariatric codes?
    I have a similar question with concerns to bariatric Dx's. Do any of you change your primary Dx from 278.01 to 278.00 once the patients BMI has dropped below 40? and have you had any problems with the claims getting paid? Do you consider once you are Dx with morbid obesity then it should stay 278.01 as primary when seen at a bariatric office?

    thanks for the help!

  7. #17
    Location
    Fort Worth Texas
    Posts
    100
    Default
    We adjust the 278.0x and the BMI dx code as they lose weight. We have never had a problem with payment. In fact, I think it shows that the patient is being successful in the weight loss and the surgery worked
    Michelle Cook,CPC, CPCO, CPMA, CEMC, CGSC, CPEDC,
    2017 AAPC MACRA Proficient

  8. Default
    Typically, after the lap gastric bypass and lap sleeve gastrectomy, the patient will have malabsorption (579.3), so we typically use that for follow-up visits, once they are out of their global period. We also use weight loss (783.21), or weight gain (783.1), depending on their situation. We also use 278.01, 278.00 or 278.02 as a secondary or tertiary diagnosis. We always use V45.86 (status-post bariatric surgery) as the tertiary or 4th diagnosis. We don't have issues with nonpayment.

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