Medicare Compliance & Reimbursement

... but most doctors don't list body mass index on patient's charts.

Physicians' offices having trouble justifying gastric-bypass or other bariatric surgery to carriers now have some relief in the form of the new weight-related ICD-9 diagnosis codes.

Starting Oct. 1, the ICD-9 diagnosis code set will include a code for "overweight" (278.02) and 18 new codes for assigning adult body mass index (BMI). "Those will be very helpful," says Lisa Frye, coder with North Carolina's Hickory Surgical Clinic, which performs bariatric surgeries and other procedures.

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, says Frye.

Right now, noting a patient's BMI on the claim form is a lot harder, says Mary Lou Walen, coding expert with the Bariatric Surgery Association. "That is great news," she says about the new codes. She assumes coders now normally list 278.1 (Morbid obesity) on the claim, followed by the appropriate V-code for BMI.

Not so fast: But don't expect doctors to start putting the patient's BMI on the chart, warns coder Cathy Satkus with Harvard Family Physicians in Tulsa, OK. Even when the doctor notes the patient's body mass, she usually won't mark it on the superbill. Doctors won't start noting this information unless payers start requiring it for more conditions, Satkus predicts.

Including the patient's BMI on claims for surgical procedures where obesity is a factor might be a good idea, notes Anne Karl, coder with St. Paul Heart Clinic in St. Paul, MN. Obesity isn't be a factor for every surgical patient, but it might be worth noting if the surgeon feels it's a complicating factor.

"I can't see us educating the physicians ... to give us the BMI when it's a factor," admits Karl, "because it's not a key indicator." But her practice has incentive programs with some payers built around programs like smoking cessation or lifestyle management, and BMI might be a useful factor for identifying target patients.