General Surgery Coding Alert

More complete diagnoses could open the door to wider coverage

Surgeons performing gastric bypass operations will welcome a new diagnosis code for "overweight," as well as new codes for body mass index.
 
This alone is good news, but the new codes will also allow payers to set guidelines for the point at which they think gastric bypass procedures stop being cosmetic and start being medically necessary.

No Longer Default to 278.1

If you're having trouble justifying gastric bypass or other bariatric surgery to carriers, the new weight-related diagnosis codes could be just what you need. Starting Oct. 1, the ICD-9 diagnosis code set will include a code for "overweight" (278.02) and 18 new codes (V85.0-V85.4) for assigning adult body mass index (BMI).

"The new codes will be very helpful," says Lisa Frye, coder with Hickory, N.C.-based Hickory Surgical Clinic, which performs bariatric surgeries. Not only will the new codes be helpful in providing the patient's BMI to payers when justifying bariatric surgeries, but they'll also provide tremendous help in justifying the initial consult, Frye speculates.

Now, noting a patient's BMI on the claim form is difficult, says Mary Lou Walen, a coder with the Bariatric Surgery Association. She assumes many coders now simply list 278.01 (Morbid obesity) on the claim.
 
Get doctors on board: If you want to use the new ICD-9 codes for BMI, you'll have to educate surgeons to include that information in the documentation coders will see. And, doctors may not start noting this information unless payers start requiring it for more conditions, predicts coder Cathy Satkus with Harvard Family Physicians in Tulsa, Okla.

Weight Might Be a Complicating Factor

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