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October 2016
Coding corner: Morbid obesity
“Once morbid obesity is diagnosed and coded as such, it’s important the diagnosis is coded the same during each visit. In order to provide the best quality of care for these patients, accurate and consistent coding plays a key role in helping identify appropriate disease and care management programs for morbidly obese patients.”
- — Dr. Raymond Hobbs, Blue Cross medical consultant
“Coding corner” is an ongoing column highlighting the importance of accurate documentation and coding for various health conditions.
With increasing numbers of our population suffering from obesity, it’s crucial for doctors to recognize the degree to which obesity and its accompanying complications can negatively affect a patient’s health.
“Overweight,” “obesity” and “morbid obesity” are distinct diagnoses that should be properly documented.
The Centers for Medicare & Medicaid Services includes morbid obesity (ICD-10-CM code E66.01) and its associated body mass index values (40 and above: ICD-10-CM code range Z68.41-Z68.45) in its ICD-10 Hierarchical Condition Categories for calendar year 2016. This categorization makes a big difference in how providers should document the condition.
From a coding perspective, documentation indicating morbid obesity in the medical record makes it easy to assign code E66.01 with an associated Z-code.
A potential coding issue occurs when only “obesity” is noted in the medical record, but there’s sufficient evidence to indicate that the patient is actually morbidly obese. For example, if the patient has a BMI over 40 and has a comorbid condition, such as osteoarthritis, sleep apnea, diabetes, coronary artery disease, hypertension, hyperlipidemia or gastroesophageal reflux disease, you should code for morbid obesity.
Can a BMI value of 40 with comorbid conditions and no mention of morbid obesity in the medical record still be used to code for morbid obesity? Yes.
According to Dr. Raymond Hobbs, Blue Cross Blue Shield of Michigan medical consultant, capturing all the medical complications associated with an obesity diagnosis helps define and document the specific clinical condition (morbid obesity).
“Because obesity is a serious health condition that often includes comorbidities, the BMI value is an important factor in identifying and treating this condition,” Dr. Hobbs said. “The impact of weight on other medical conditions can be significant, so it’s important that all clinical complications be evaluated as part of the patient’s diagnosis and treatment.”
The health care provider might not document morbid obesity in its early stages as he or she may decide to evaluate the patient over time and recommend several interventions that could help reverse the trend. These may include referral to a dietitian, helping the patient incorporate an exercise regimen into his or her daily routine or education about how the condition can affect overall health.
To sum up, documentation is key to coding morbid obesity. A coder must review the medical record thoroughly when only obesity is documented but the patient has a BMI of 40 or above, along with comorbid conditions affecting the patient’s overall health. In these circumstances, code for morbid obesity.
To access a flier on this topic, click here.
None of the information included in this article is intended to be legal advice and, as such, it remains the provider’s responsibility to ensure that all coding and documentation are done in accordance with applicable state and federal laws and regulations.
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