Are you coding adult BMI assessment correctly when reporting evaluation and management services?

It has come to our attention that some health care providers have been reporting the ICD-9 codes for adult body mass index assessment in the primary diagnosis location on claims, which may cause the claims to reject.

To capture information about BMI for your adult patients, use ICD-9 codes V85.0, V85.1, V85.21-25, V85.30-39 or V85.41-45. The BMI codes should only be reported as secondary diagnosis for evaluation and management services.

Adult BMI assessment is a key HEDIS^® measure**, so not documenting it correctly can affect HEDIS scores. These scores, as you may know, are tied to incentive payments through our Physician Group Incentive Program.

In addition to PGIP physician organizations being rewarded for their HEDIS improvement efforts (including adult BMI), PGIP participating primary care physicians are also eligible for a 5 percent fee uplift based on their overall quality performance on a variety of HEDIS metrics. Adult BMI is being added as one of the quality metrics contributing to this physician-level opportunity for elevated fees.

For more information on adult BMI assessment, see our tip sheet on this topic by clicking here.

Note: For evaluation and management services, V codes are collected for informational purposes only and are not directly reimbursable.

**HEDIS, which stands for Healthcare Effectiveness Data and Information Set, is a registered trademark of the National Committee for Quality Assurance.