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Encounter for weight loss Rx

  1. #1
    Default Encounter for weight loss Rx
    Exam Training Packages
    We have a patient who first presented to our office requesting help with her weight loss, we now have her on phentermine and has been coming back for a follw-up visit for this medication refill. Her insurance does not cover an obseity diagnosis. Is there another way to go about billing these visits>? Any advice and feedback would be much appreciated! Thanks.

  2. #2
    Default Reference

    Here is a resource with diagnoss and procedure codes. Are there any existing or developing conditions associated with the patient's weight which insurance may cover? There is a big push to address BMI as part of preventative care. So you might be able to research your insurance companie's medical policies regarding BMI as a place to start.

    It is for children and adolescents. But gives a good starting point.

    Hope this helps. Feel free to instant message with your results.

  3. #3
    Columbia, MO
    I disagree with looking for other conditions when the reason for the encounter is obesity and obesity management. If her insurance does not cover this then the patient will need to be billed for the encounter. I do agree with using the appropriate BMI along with the obesity code.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
    Default Agree
    You are correct. If the purpose of the office visit is determined and diagnosed by the provider as obesity, it would not be appropriate to code for an associated condition for reimbursement concerns.

    I do try to encourage my providers to be more specific regarding visits like these to express accurately and clearly, why the patients weight/BMI is a concern/medical risk.

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