Coding Obesity
We have all heard the news…”We are the most overweight country in the world.”. I am not sure how accurate that is, but statistics do paint a not so good picture.
1 in 3 adults and 1 in 5 children are obese.
1 in 4 young adults is to heavy to serve in our military.
Obesity cost the U.S. healthcare system $147 billion a year.
40 percent of all U.S. households do not live within one mile of healthy food retailers.
There are more statistics but these are glaringly obvious. We have a problem. What stands out the most are the issues that arise directly related to obesity. Diabetes, heart disease, stroke, and even some forms of cancer as well as mental health conditions such as depression. Lets look at the proper way to code for obesity.
Coding Body Mass Index
The terms “overweight” and “obesity” are sometimes used interchangeably by providers. Coders should be aware of the difference to select the correct diagnosis code. The most common way to determine the correct diagnosis code is to use the patient’s body mass index (BMI). BMI is calculated using a person’s weight in kilograms (pounds) divided by the square of height in meters(inches) (BMI=weight (kg)/((height(m)2) or weight (lb)/(height (in)2)x703).
In Table A, you will see the ranges and codes used for BMI. A patient with a BMI of 35.0 would be considered obese. You would use ICD-10 codes E66.01 and Z68.35. You should always have two ICD-10 codes on your claim: the first for the type of obesity and the second to identify the BMI.
TABLE A
BMI Range ICD-10 CM Code BMI Codes
<18.5 Underweight R63.6 Z68.1
18.5 to 24.9 Healthy N/A Z68.1-Z68.24
25.0 to 29.9 Overweight E66.3 Z68.25-Z68.29
30.0 to 34.9 Obese E66.01 Z68.30-Z68.34
35.0 to 39.9 Obese E66.01 Z68.35-Z68.39
=>40 Obese(severe) E66.01 Z68.41-Z68.45
There are other obesity codes such as obesity complicating pregnancy, localized adiposity (large accumulation of fat at various parts of the body), drug induced obesity, and Pickwickian syndrome (morbid severe obesity with hypoventilation). It’s important to review the chart to get an exact picture of what is going on with the patient.
BMI is usually obtained by clinical staff and documented while taking a patient’s vital signs. If the provider is truly managing the patient’s obesity, their BMI should be coded along with the correct code for the type of obesity.
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