General Surgery Coding Alert

Question: Our surgeons perform bariatric surgery, and BMI is one of the factors considered for medical necessity. I heard that ICD-10 2020 changes the BMI codes. Can you please explain the changes?

Tennessee Subscriber

Answer: You will find minor changes to the Body Mass Index (BMI) codes in ICD-10-CM 2020, which is effective Oct. 1, 2019. The changes are minor, so should have little impact on medical necessity for bariatric surgery in most cases.

Specifically: ICD-10-CM 2020 changes the age range for BMI adult codes from “21 years of age or older” to “20 years of age or older,” and the pediatric codes from “2-20 years of age” to “2-19 years of age.” The latest version of the code set also adds the note, “These percentiles are based on growth charts published by the Centers for Disease Control and Prevention (CDC).” The change could potentially impact coverage for bariatric surgery for a 20-year-old patient.

The only other minor change to BMI codes in the updated code set revises Z68.43 from (Body mass index (BMI) 50-59.9, adult) to (Body mass index (BMI) 50.0-59.9, adult).