Coding, Classification and Reimbursement

Obesity/BMI

  • 1.  Obesity/BMI

    Posted 16 days ago

    We have not been coding BMI and the associated diagnosis unless there is documentation to support as a reportable additional diagnosis per guidelines. I came across an ICD-10 Monitor article that addresses a coding clinic from 2018 Q4 that advises overweight/obesity is still considered clinically significant and should be coded. We will not have access to 2018 Q4 coding clinic until our next 3M update in January. We want to make sure this information is correct so that we are coding these diagnoses appropriately as they can affect DRG/SOI/ROM.  Does anyone have access to 2018 Q4 Coding Clinic that addresses the coding of overweight/obesity that can validate this? 



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    Laura Haskell
    IP Coding Supervisor
    Lee Memorial Hospital
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  • 2.  RE: Obesity/BMI

    Posted 16 days ago
    Edited by Patricia Maccariella-Hafey 11 days ago
    Yes you are correct. The CC4Q2018 page 77 has several scenarios of obestiy and BMI coding. In one the inquirer asked if there had to be clinical signficance documented in order to code obesity. AHA responded with "Obesity and morbid obesity are always clinically significant and reportable when documented by the provider. In addition, if documented, the body mass index (BMI) code may be coded in addition to the obesity or morbid obesity code."

    I hope this helps. Hope you get that CC issue soon.

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    Patricia Maccariella-Hafey
    Executive Director of Education
    Health Information Associates
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  • 3.  RE: Obesity/BMI

    Posted 16 days ago
    ​Thank you so much:)

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    Laura Haskell
    Ip Coding Supervisor
    Lee Memorial Hospital
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  • 4.  RE: Obesity/BMI

    Posted 13 days ago
    ​Hello!

    As per Pat's response.  I am commenting regarding Coding Clinic.  Specifically, the problem with relying on encoder vendors copies of Coding Clinic.  A few years ago, AHA began an issuing an effective date for Coding Clinic more or less equal to the release date.  The 4th Quarter 2018 issue became effective on October 8, 2018.

    Ever since I discover Coding Clinic issues were going into effect before encoder vendors were updating their software, I have maintained my own subscription.

    Every place has the right to set their own policies including how to obtain Coding Clinic.  I just want to make a couple of observations,  No entity has the right to "copy" Coding Clinic advice word for word without the permission of AHA.  Advice in Coding Clinic goes into effect with the date published in the issue.  The 4th QTR 2018 issue is 94 pages long.  Without receiving issues on a timely basis, you may be incorrectly coding any topic included in the issue until your vendor updates their software in January 2019.

    Finally, and I do not go around informing AHA of copyright violations, but excessive copying of Coding Clinic is a copyright infringement.  I frequently cite CC's, but only for a specific topic and I always try to "footnote" or give the appropriate issue information (date, page(s), etc.).

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    Lawrence Barr
    President
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  • 5.  RE: Obesity/BMI

    Posted 13 days ago
    Hi Lawrence,
    I wish I could have my own subscription, but it is quite expensive.
    What always bothered me was ,that the two AHIMA coding assessments we have to take every year are completely based on the CC.
    Unless you work as a coder you don't have any access to it. I wish we would get some discount through AHIMA.

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    Rivona Wasserman
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  • 6.  RE: Obesity/BMI

    Posted 13 days ago
    Rivona,

    You may be already aware of this but I believe the yearly Coding Assessments are not scored and therefore, there is no passing requirement. You only need to complete it so that it satisfies the coding credential CEU requirement for that year.  I understand that it may be challenging and time-consuming to complete these assessments, and for those who don't have access to Coding Clinic they lack the convenience to check their answers immediately.


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    Cristina Co
    Facility Outpatient Coder
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  • 7.  RE: Obesity/BMI

    Posted 13 days ago
    Thank you, Lawrence, for the reminder about copyright violations. AHA Coding Clinic is a paid subscription. Although there is the fair use exemption that may allow us to copy some of the material, it is more than likely we may be copying the main thought and that defeats the purpose of this exemption.  When in doubt, do not copy the entire Coding Clinic entry exactly as written even though you are citing it.

    Again, I appreciate the reminder!


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    Cristina Co
    Facility Outpatient Coder
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  • 8.  RE: Obesity/BMI

    Posted 12 days ago
    The official coding guideline addresses this in that BMI is coded only if obesity is documented by the provider. In that case, the BMI can be coded from other than a provider's documentation.

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    Michelle A. Green, MPS, RHIA, FAHIMA, CPC
    SUNY Distinguished Teaching Professor
    Mohawk Valley Community College
    Utica NY
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  • 9.  RE: Obesity/BMI

    Posted 11 days ago
    ​Hi Laura
    Obesity/Morbid obesity may be coded if noted by the provider as it is still clinically significant to code should this be identified (pg. 77, 79-80).   Unfortunately though there is conflicting information in the coding clinic regarding the diagnosis of overweight. Page 78 states that it cannot be coded without meeting the criteria of a reportable secondary diagnosis however on pages 79-80, it says it can citing Official Guidelines for Coding & Reporting Section 1.A.19 - assigning a diagnosis based on the providers' diagnostic statement that the condition does exist.

    BMI can be reported when these diagnoses are documented, and do not require the attending to document it as such - similar to coding the stage of a pressure ulcer.  In my honest opinion, there really has been no change to the coding guideline for obesity/morbid obesity and BMI.  This years' update only further clarified when BMI can/should be reported.  Otherwise, nothing else has changed.  The guideline to code obesity/morbid obesity is the same in 2018 as it was previously in 2011 (3rd Qtr. 2011, pg. 3-4).

    Has anyone approached AHA CC about the conflicting instruction?

    Hope this helps!

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    Lynn A. Wall, RHIT, CCS
    Interim Coding Supervisor
    Maricopa Integrated Health System
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  • 10.  RE: Obesity/BMI

    Posted 10 days ago
    I don't think it is conflicting.  Morbid obesity and obesity would be considered always clinically significant but being overweight is not.

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    Chrystel Barron, RHIA, CCS, CCS-P, CHTS-TR, CICA
    Coding Education Instructor
    Cleveland Clinic Health System
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