# Obesity coding with comorbidities



## hunters (Sep 5, 2013)

I am coding for a weight management facility where the patients are coming in for weight management/obesity counseling. Can we list/code their co-morbidities following the obesity and BMI code - even if the physician doesn't assess or treat the comorbidities?  The comorbidities (such as HTN or Vit D deficiency) are mentioned only as "pt has history of xxxxx, xxxxx" in the HPI, but thats it.  Then those comorbidities - and sometimes additional ones that weren't even mentioned in the HPI - are listed in the diagnosis list as "comment only".   So my question is whether or not I can list all these comorbidities in addition to the obesity diagnosis.   I've always been taught that if it wasn't part of the chief complaint and if it wasn't addressed, evaluated, and treated - then you don't code it or count it.  But I'm finding that if I don't list the comorbidities, insurances are denying the claims with just the obesity and BMI diagnosis.  Is it just a matter of the physician needing to do more documentation or can I bill the comorbities simply because they are listing them at the bottom of the office note?

PLEASE HELP !!


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## latonna1 (Sep 5, 2013)

*Your help*

You are thinking in the right direction. Since Morbid Obesity is now considered a chronic condition that's a BMI 40 or greater. If you have co-morbidity w/ a BMI of 35 and greater the physician must reference those co morbid dx in the body of the note. So if you are able educate him/her on that.


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## hunters (Sep 9, 2013)

Thanx so much for your response!  I agree with you 100%.  I've been researching on this site and all over the net looking for something to support this so I can show it to the physicians.  I even searched the cms.gov site in their manuals and simply can not find anything that discusses how co-morbidities must be assessed and/or treated in order to be coded/billed on the claim.  My physicians (and some other coders) feel that the fact the patient has the co-morbidites at all and that the obesity can affect them means they need to be billed, even if they aren't the ones treating the co-morbidites.  Do you (or anyone) know where I can find any documentation on this issue, one way or the other?  I just want to code it right.


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## PVAzCPC (Sep 9, 2013)

hunters said:


> Thanx so much for your response!  I agree with you 100%.  I've been researching on this site and all over the net looking for something to support this so I can show it to the physicians.  I even searched the cms.gov site in their manuals and simply can not find anything that discusses how co-morbidities must be assessed and/or treated in order to be coded/billed on the claim.  My physicians (and some other coders) feel that the fact the patient has the co-morbidites at all and that the obesity can affect them means they need to be billed, even if they aren't the ones treating the co-morbidites.  Do you (or anyone) know where I can find any documentation on this issue, one way or the other?  I just want to code it right.



I do not have an answer for you, but I do have an addition to your original premise, and that is I am struggling with the same type question for all types of comorbidities, ie: patients with diabetes, COPD, etc., all these conditions have to be taken into account when considering treatment options for any given encounter.  Are these all coded as well, every time the patient comes in, whether actually addressed or not?


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## hunters (Sep 9, 2013)

Very good point HumDewCoder......Here is an HPI example of what I'm dealing with:
_65 yr old female presents for weight mnmgt f/u.  Weight: 274 today. last weight unchanged. pt has decreased bodyfat mass by 2 pounds and increased muscle mass by 2 pounds. pt states diet is going well. adhering strictly. water intake good. sleep good. pt states she is compliant with vitamins. no new medical issues. pt has been using stair stepper for exercise and plans to invest in a recumbant bike. _
As you can see, not a single co-morbidity was mentioned and in the Plan, it only lists things like 1) drink 6-8 glasses of water a day 2) get 8 hours sleep a night 3) exercise minimum 5 days a week 4) keep daily food log, etc.; however, in the final assessment/diagnosis list - they give HTN, Vit D Deficiency, Sleep Apnea, and Obesity.  Now I know to code the Obesity 1st followed by the BMI code.....but I'm really struggling with coding these co-morbities.


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## PVAzCPC (Sep 20, 2013)

I think too, that there is a difference between coding the co-morbidities, and billing for them.  I would say code them, as pertinent to treatment, but do not bill as they were not directly assessed in this encounter?


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## Melissasuewashburn (Nov 4, 2013)

I would argue that in this particular case you could argue for coding the Vit D deficiency since the note does mention that she is compliant with vitamins, since the treatment for Vit D is taking supplements - especially if the patient is on a high-dose Vit D supplement.


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