Morbid obesity icd 10

Coding Clinic 4 th Quarter 2018 had an extensive question and answer section seeking to clear up any confusion regarding BMI coding. Much of the information was a reiteration of what has already been published in prior Coding Clinic issues and the Official Guidelines for Coding and Reporting. Below is a summary of the key points and other highlights from this issue including lacunar infarctions, gangrene and perforation of gallbladder, extracorporeal membrane oxygenation (ECMO), and spinal fusion. Body Mass Index (BMI) Coding • BMI codes can only be assigned when a c orresponding clinical condition such as overweight, obesity or morbid obesity underweight, malnutrition, anorexia nervosa or other eating disorders, cachexia, and abnormal weight loss/gain is documented • If the linkage between the BMI and a clinical condition is not clearly documented, q uery the provider for clarification • Obesity and morbid obesity are always clinically significant and reportable when documented by the provider • If morbid obesity is documented, assign E66.01, morbid obesity due to excess calories, even if the patient’s BMI is below 40 • Per the Official Coding Guidelines: The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. • The provider’s statement that the patient has a particular condition is sufficient. • Code assignment is not based on clinical criteria used by the provider to establish the diagnosis • Documentation of “overwe...

Overview What is morbid obesity (now known as class III obesity)? Class III obesity, formerly known as morbid obesity, is a complex chronic disease in which a person has a Class III obesity can contribute to the development of several serious health conditions, such as Type 2 diabetes and heart disease. The good news is that class III obesity is manageable and treatable. Why was class III obesity called morbid obesity? The term “morbid obesity” was coined by two healthcare providers in 1963 in order to justify insurance reimbursement for the cost of intestinal bypass surgery for weight loss in people with a BMI over 40. In a medical setting, “morbidity” means illness or disease. Healthcare professionals also often use the term “comorbidity,” which means that an individual has more than one illness or disease occurring at the same time. The medical meaning of “morbid” is appropriate in describing this type of obesity since class III obesity is considered a disease and is often associated with other chronic health conditions. The problem is that, like many words, “morbid” has another meaning. Outside of the medical setting, “morbid” means disturbing or unpleasant. Since most people aren’t familiar with the medical definition, they connected morbid (class III) obesity and people with obesity to those negative words. The use of “morbid” in describing obesity adds to the false and problematic societal stigma that suggests that people with obesity lack the willpower to lose weig...

I have a HCC coding question about Class II obesity with comorbidities. The patient has a BMI of 38.23 with comorbidities of hypertension and DM. Documentation states patient is obese and recommends patient to lose weight by exercise. SnoMed stated Class II obesity with severe comorbidities is not E66.01 but E66.9. Where can I find tangible information that severe is Class II? There a lot of references saying different things. Can the documentation state serious instead of severe? Also if the BMI is 38.23 and the physician documents Morbid obesity instead of Severe obesity with comorbidities, is that sufficient? Please help 1. If Morbid Obesity is documented in the PMH, Problem, chronic, current list, the BMI must be 40 or higher to be able to code the E66.01. 2. If the Morbid Obesity is documented anywhere else in the note that is not the PMH, Problem, chronic, current list, E66.01 can be coded if the documented BMI is 35 or higher. 3. If the BMI is not documented, and Morbid Obesity is documented anywhere else in the note that is not the PMH, Problem, chronic, current list, E66.01 can be coded. Just remember-Obesity (E66.9) does not risk adjust and anything below Z68.35 does not risk adjust. Also, remember, you are the coder and you can only code what the Provider documents, no exceptions. If it is not documented it never happened. Hope this helps, this is how I was advised. Janice Randall-Payne BS, CPC-I, COC, CPC, CCS-P, PCS, CPAR AHIMA-Approved ICD-10-CM/PCS Trainer

Hierarchical condition category (HCC) coding is a risk-adjustment model originally designed to estimate future health care costs for patients. The Centers for Medicare & Medicaid Services (CMS) HCC model was initiated in 2004 and is becoming increasingly prevalent as the environment shifts to value-based payment models. HCC coding relies on ICD-10-CM coding to assign risk scores to patients. Each HCC is mapped to an ICD-10-CM code. Along with demographic factors such as age and gender, insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score. Using algorithms, insurance companies can use a patient’s RAF score to predict costs. For example, a patient with few serious health conditions could be expected to have average medical costs for a given time. However, a patient with multiple chronic conditions would be expected to have higher health care utilization and costs. Why is HCC coding important? Hierarchical condition category coding helps communicate patient complexity and paint a picture of the whole patient. In addition to helping predict health care resource utilization, RAF scores are used to risk adjust quality and cost metrics. By accounting for differences in patient complexity, quality and cost performance can be more appropriately measured. Risk Adjustment and Value-Based Payment Risk adjustment can play an important role in payment, and this is particularly true in value-based payment (VBP). VBP arrangements use a practice’s perf...

Overview What is morbid obesity (now known as class III obesity)? Class III obesity, formerly known as morbid obesity, is a complex chronic disease in which a person has a Class III obesity can contribute to the development of several serious health conditions, such as Type 2 diabetes and heart disease. The good news is that class III obesity is manageable and treatable. Why was class III obesity called morbid obesity? The term “morbid obesity” was coined by two healthcare providers in 1963 in order to justify insurance reimbursement for the cost of intestinal bypass surgery for weight loss in people with a BMI over 40. In a medical setting, “morbidity” means illness or disease. Healthcare professionals also often use the term “comorbidity,” which means that an individual has more than one illness or disease occurring at the same time. The medical meaning of “morbid” is appropriate in describing this type of obesity since class III obesity is considered a disease and is often associated with other chronic health conditions. The problem is that, like many words, “morbid” has another meaning. Outside of the medical setting, “morbid” means disturbing or unpleasant. Since most people aren’t familiar with the medical definition, they connected morbid (class III) obesity and people with obesity to those negative words. The use of “morbid” in describing obesity adds to the false and problematic societal stigma that suggests that people with obesity lack the willpower to lose weig...

Hierarchical condition category (HCC) coding is a risk-adjustment model originally designed to estimate future health care costs for patients. The Centers for Medicare & Medicaid Services (CMS) HCC model was initiated in 2004 and is becoming increasingly prevalent as the environment shifts to value-based payment models. HCC coding relies on ICD-10-CM coding to assign risk scores to patients. Each HCC is mapped to an ICD-10-CM code. Along with demographic factors such as age and gender, insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score. Using algorithms, insurance companies can use a patient’s RAF score to predict costs. For example, a patient with few serious health conditions could be expected to have average medical costs for a given time. However, a patient with multiple chronic conditions would be expected to have higher health care utilization and costs. Why is HCC coding important? Hierarchical condition category coding helps communicate patient complexity and paint a picture of the whole patient. In addition to helping predict health care resource utilization, RAF scores are used to risk adjust quality and cost metrics. By accounting for differences in patient complexity, quality and cost performance can be more appropriately measured. Risk Adjustment and Value-Based Payment Risk adjustment can play an important role in payment, and this is particularly true in value-based payment (VBP). VBP arrangements use a practice’s perf...

Coding Clinic 4 th Quarter 2018 had an extensive question and answer section seeking to clear up any confusion regarding BMI coding. Much of the information was a reiteration of what has already been published in prior Coding Clinic issues and the Official Guidelines for Coding and Reporting. Below is a summary of the key points and other highlights from this issue including lacunar infarctions, gangrene and perforation of gallbladder, extracorporeal membrane oxygenation (ECMO), and spinal fusion. Body Mass Index (BMI) Coding • BMI codes can only be assigned when a c orresponding clinical condition such as overweight, obesity or morbid obesity underweight, malnutrition, anorexia nervosa or other eating disorders, cachexia, and abnormal weight loss/gain is documented • If the linkage between the BMI and a clinical condition is not clearly documented, q uery the provider for clarification • Obesity and morbid obesity are always clinically significant and reportable when documented by the provider • If morbid obesity is documented, assign E66.01, morbid obesity due to excess calories, even if the patient’s BMI is below 40 • Per the Official Coding Guidelines: The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. • The provider’s statement that the patient has a particular condition is sufficient. • Code assignment is not based on clinical criteria used by the provider to establish the diagnosis • Documentation of “overwe...

I have a HCC coding question about Class II obesity with comorbidities. The patient has a BMI of 38.23 with comorbidities of hypertension and DM. Documentation states patient is obese and recommends patient to lose weight by exercise. SnoMed stated Class II obesity with severe comorbidities is not E66.01 but E66.9. Where can I find tangible information that severe is Class II? There a lot of references saying different things. Can the documentation state serious instead of severe? Also if the BMI is 38.23 and the physician documents Morbid obesity instead of Severe obesity with comorbidities, is that sufficient? Please help 1. If Morbid Obesity is documented in the PMH, Problem, chronic, current list, the BMI must be 40 or higher to be able to code the E66.01. 2. If the Morbid Obesity is documented anywhere else in the note that is not the PMH, Problem, chronic, current list, E66.01 can be coded if the documented BMI is 35 or higher. 3. If the BMI is not documented, and Morbid Obesity is documented anywhere else in the note that is not the PMH, Problem, chronic, current list, E66.01 can be coded. Just remember-Obesity (E66.9) does not risk adjust and anything below Z68.35 does not risk adjust. Also, remember, you are the coder and you can only code what the Provider documents, no exceptions. If it is not documented it never happened. Hope this helps, this is how I was advised. Janice Randall-Payne BS, CPC-I, COC, CPC, CCS-P, PCS, CPAR AHIMA-Approved ICD-10-CM/PCS Trainer

Hierarchical condition category (HCC) coding is a risk-adjustment model originally designed to estimate future health care costs for patients. The Centers for Medicare & Medicaid Services (CMS) HCC model was initiated in 2004 and is becoming increasingly prevalent as the environment shifts to value-based payment models. HCC coding relies on ICD-10-CM coding to assign risk scores to patients. Each HCC is mapped to an ICD-10-CM code. Along with demographic factors such as age and gender, insurance companies use HCC coding to assign patients a risk adjustment factor (RAF) score. Using algorithms, insurance companies can use a patient’s RAF score to predict costs. For example, a patient with few serious health conditions could be expected to have average medical costs for a given time. However, a patient with multiple chronic conditions would be expected to have higher health care utilization and costs. Why is HCC coding important? Hierarchical condition category coding helps communicate patient complexity and paint a picture of the whole patient. In addition to helping predict health care resource utilization, RAF scores are used to risk adjust quality and cost metrics. By accounting for differences in patient complexity, quality and cost performance can be more appropriately measured. Risk Adjustment and Value-Based Payment Risk adjustment can play an important role in payment, and this is particularly true in value-based payment (VBP). VBP arrangements use a practice’s perf...

Coding Clinic 4 th Quarter 2018 had an extensive question and answer section seeking to clear up any confusion regarding BMI coding. Much of the information was a reiteration of what has already been published in prior Coding Clinic issues and the Official Guidelines for Coding and Reporting. Below is a summary of the key points and other highlights from this issue including lacunar infarctions, gangrene and perforation of gallbladder, extracorporeal membrane oxygenation (ECMO), and spinal fusion. Body Mass Index (BMI) Coding • BMI codes can only be assigned when a c orresponding clinical condition such as overweight, obesity or morbid obesity underweight, malnutrition, anorexia nervosa or other eating disorders, cachexia, and abnormal weight loss/gain is documented • If the linkage between the BMI and a clinical condition is not clearly documented, q uery the provider for clarification • Obesity and morbid obesity are always clinically significant and reportable when documented by the provider • If morbid obesity is documented, assign E66.01, morbid obesity due to excess calories, even if the patient’s BMI is below 40 • Per the Official Coding Guidelines: The assignment of a diagnosis code is based on the provider’s diagnostic statement that the condition exists. • The provider’s statement that the patient has a particular condition is sufficient. • Code assignment is not based on clinical criteria used by the provider to establish the diagnosis • Documentation of “overwe...