Gastroenterology Coding Alert

Question: The Centers for Medicare & Medicaid Services has added 18 new V codes to test for body mass index (BMI). How will this affect gastroenterology offices?


New York Subscriber

Answer: Although CMS has yet to release coding guidelines for the V codes (V85.0-V85.4), the agency most likely intends to use them for information only. Even so, the codes could lead to denials, so be sure to avoid assigning them if they are not related to the current condition the gastroenterologist is treating.

Reason: Many insurers don't cover obesity-related conditions. Adding V85.0-V85.4 to a claim simply because the physician states the patient's BMI in the notes may give the carrier leverage to deny the claim as an "uncovered obesity service."

In rare instances, you may find the V codes appropriate on a claim if the gastroenterologist prescribes a patient medication that only persons over a certain weight can take.

Also, including the patient's BMI on claims for surgical procedures when obesity is a factor might be a good idea, says Anne Karl, coder with St. Paul Heart Clinic in St. Paul, Minn. Obesity isn't relevant for every patient, but it might be worth noting as a secondary diagnosis if the gastroenterologist thinks it's a complicating factor in the patient's treatment or recovery.

For example: "The BMI V codes could possibly be used in the case of a patient who is morbidly obese and is having a colonoscopy. Obesity sometimes makes it more difficult to advance the scope in these patients," says Linda Parks, MA, CPC, CMC, CMSCS, an independent coding consultant.

However, Parks does not think the BMI codes will be difference-makers, at least in the first year or two. "At this time, I feel they are more for informational purposes. Since obesity is in the news more now, maybe they (Medicare officials) are attempting to figure out just how big of a problem it really is," Parks says.