# increased BMI IN PREGNANY CODE ? OBESITY



## ldk4 (Jun 26, 2011)

What would be the appropriate code for Increased BMI for out pt services during pregnancy? No info. documented by DR. for  "Increased BMI"..


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## preserene (Jun 26, 2011)

Yes Obesity complicating pregnancy-649.1x along with the Vcode 85.series, if you know the age of the patient an dthe value of BMI. If you do not hav ethose, then you would have to go for 278.00/ 278.01 or if you know it only by overwieght  then you could think of 278.02  with the BMI between 25 and 29.9.If you are not convinced , pleas equiry the doctor for more specification. 
thank you.


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## mitchellde (Jun 26, 2011)

You cannot code for the obesity since the provider did not document obesity.  An increased BMI could indicate overweight wich is different from obese.  The provider should be queried for clariety


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## ldk4 (Jun 27, 2011)

*Obesity increased BMI in Pregnancy*

Thank you, will query Dr...


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## preserene (Jun 27, 2011)

*Obesity increased bmi in pregnancy*

STUDY SUGGESTS OBESE WOMEN SHOULD NOT GAIN WEIGHT DURING PREGANCY
Findings challenge American College of Obstetricians and Gynecologists pregnancy guidelines
A new study challenges the prevailing wisdom that to improve pregnancy outcomes, all women, even those who are obese, should gain weight during pregnancy.
For years, doctors and other health-care providers have managed pregnant patients according to guidelines issued by the American College of Obstetricians and Gynecologists (ACOG). In 1986, ACOG stated, “Regardless of how much women weigh before they become pregnant, gaining between 26-35 pounds during pregnancy can improve the outcome of pregnancy and reduce their chances of having the pregnancy end in fetal death.” The Institute of Medicine (IOM) recommends that overweight women should gain about 15 pounds during pregnancy. 
The current study was undertaken to test whether these guidelines make a difference in maternal-fetal outcomes among obese women. In the study, conducted at several hospitals, the researchers followed 232 obese pregnant women, all of whom had a body mass index (BMI) of 30 or greater. Half of the women followed conventional prenatal nutritional guidelines, which is essentially “eat to appetite” (control group). The other half were placed on a well-balanced, nutritionally monitored program, which included a daily food diary (study group). The average weight gain in the control group was 31 pounds, compared to 11 pounds in the study group. Twenty-three extremely obese patients lost weight during their pregnancy. 
The findings showed that there were no fetal deaths and no growth-restricted infants in the study group. Also, there were fewer babies weighing more than 10 pounds in the study group than in the control group. (A birth weight over 10 pounds poses significant hazards to both infants and mothers.) Moreover, women in the study group gained less weight, had fewer cesarean deliveries, were less likely to develop gestational diabetes, and retained less weight after they delivered than women in the control group. 
The researchers concluded that obese pregnant women may be placed on a healthy, well balanced, monitored nutritional program without adverse maternal-fetal outcomes. 
“Women who are obese when beginning a pregnancy are, by definition, unhealthy,” says study leader Yvonne S. Thornton, MD, MPH, a clinical professor of obstetrics and gynecology and board-certified specialist in maternal-fetal medicine at New York Medical College. “To say that they should gain even more weight is counter-intuitive, and our study bears that out. Rather than focusing on numerical endpoints with respect to weight gain, we need to focus on making these women healthier by getting them to eat a well-balanced diet.” 
“Gaining weight during pregnancy contributes to obesity, and it makes it that much harder for overweight women to return to their normal weight after pregnancy,” says Dr. Thornton. Dr. Thornton’s paper, “Perinatal Outcomes in Nutritionally Monitored Obese Pregnant Women: A Randomized Clinical Trial,” was published in the June issue of the Journal of the National Medical Association.]
The bottom line is this for us to know:-  
Obesity Complicating Pregnancy is one of the high risk pregnancies since long including the mechanical complications even in cesarean, and as such it influences pregnancy-delivery management and outcome.  This (obesity per se) is a matter of great concern since 4-5 decades in pregnancy and outcome. *Our ICD -9 code manual elaborates us to code an addition code to signify obesity and the BMI factor-278.0x, along with 649.1x .*So when Pregnancy+ obesity = complication anticipated.
Pregnancy + weight gain in pregnancy (not proportionate to the norms of pregnancy)= anticipated complication.
The obgyn concerns are mainly on the obesity which could complicate the pregnancy outcome , management in many steps of the way. The increase in weight during pregnancy after the mid or late 2nd trimester is also a great concern for fetal/ maternal medical complications ,more so when proteinurea and rise in blood pressure. 
Since obesity and pregnancy is documented and being the main concern in pregnancy in our case scenario, I suggested that obesity complicating Pregnancy could be coded( with the concurrence of the Physician). Is it not a justification to code from chapter 11 series and chapter 11 code as always given priority, if the diagnosis is documented. 
Well the code from  278.0x -278.02  should also be given , depending on the BMI value.
These codes would be sequenced as said before and V code can also be a supportive diagnosis.
Thank you very much anyway , it is a controversial topic though.


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## mitchellde (Jun 27, 2011)

preserene said:


> STUDY SUGGESTS OBESE WOMEN SHOULD NOT GAIN WEIGHT DURING PREGANCY
> Findings challenge American College of Obstetricians and Gynecologists pregnancy guidelines
> A new study challenges the prevailing wisdom that to improve pregnancy outcomes, all women, even those who are obese, should gain weight during pregnancy.
> For years, doctors and other health-care providers have managed pregnant patients according to guidelines issued by the American College of Obstetricians and Gynecologists (ACOG). In 1986, ACOG stated, “Regardless of how much women weigh before they become pregnant, gaining between 26-35 pounds during pregnancy can improve the outcome of pregnancy and reduce their chances of having the pregnancy end in fetal death.” The Institute of Medicine (IOM) recommends that overweight women should gain about 15 pounds during pregnancy.
> ...



The PHYSICIAN did not document the patient is obese!  An increase in BMI is not the same as obese, it could mean the patient is approaching overweight status, which is not obese.  We cannot read into what the diagnosis might be there are different levels of overweight.  Your advice would be applicable if the provider had documented that the patient was obese with an increasing BMI


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