Coding corner: Morbid obesity

Morbid obesity is a serious condition that typically builds slowly over time and leads to symptoms that interfere with basic physical functions, such as breathing, sleeping and walking. Long-term effects include shorter life expectancy and co-morbid conditions, such as Type 2 diabetes mellitus, heart disease, high blood pressure and obstructive sleep apnea.

The National Institutes of Health define morbid (severe) obesity in adults as:

• BMI of 35 kg/m2 or one or more co-morbid conditions that can be linked to obesity
• BMI of 40 kg/m2, regardless of conditions
• More than 100 pounds over ideal body weight

Many providers are reluctant to document "morbid obesity" or "severe obesity" for fear of offending patients, but patients need an accurate understanding of their condition, and its detrimental effects on their overall health.

It’s appropriate to document "obesity" if the patient doesn’t meet any of the criteria listed above. On the other hand, if the patient meets one of the criteria for morbid (severe) obesity, it should be documented as such.

In addition, the provider should document any interventions or recommendations made during the visit to help the patient lose weight. This may include diet and exercise counseling, referral to a dietitian or a bariatric surgeon.

Coding tips

• To assign code E66.01, the provider must specifically document either "morbid obesity" or "severe obesity" in the record and have a documented plan or intervention that addresses the patient’s morbid obesity.
• When the provider documents "obesity" or "overweight," this leads to assignment of codes E66.9 or E66.3, respectively. This would be inappropriate in a patient who meets criteria for morbid obesity as it will reflect a lower than accurate severity of illness.
• Documentation of the BMI value allows assignment of a separate set of codes (Z68.XX). Assignment of these codes at least once a year is an essential quality measure.
• If the patient’s BMI is higher than normal (greater than 25), the provider must also document a clinical descriptor based on his or her interpretation of the BMI, such as "obese," "morbidly obese" or "overweight." This is especially important for patients with a BMI of 40 or greater as they meet the definition of morbid (severe) obesity.