Pediatric Coding Alert
Know the Dos and Don’ts of Pediatric BMI Documentation
Here’s how to assign the Z68.5- codes correctly. Whether you’re documenting body mass index (BMI) for a pediatric patient who is overweight, underweight, who has an eating disorder, or who is in the normal height and weight range for their age and gender, assigning a code from Z68.- (Body mass index [BMI]) isn’t always straightforward. So, here are four things you need to do — and three things that you shouldn’t — to keep your BMI coding healthy. Do Use the Pediatric BMI Codes for Your Pediatric Patients It may seem obvious, but before you assign a BMI code to any patient, make sure you know the patient’s age. The Z68.- codes are divided between adults, defined by ICD-10 as persons 20 years of age or older, and children, defined as persons 2-19 years of age. Why? As a child grows, their height, weight, and body fat change rapidly, whereas adult heights stay pretty much the same for life and weights and body fat in adults fluctuate slowly. Consequently, adult BMI code descriptors reflect absolute BMI measurements, but pediatric BMI codes are expressed as percentiles: Do Use a Growth Chart to Determine the Correct Pediatric BMI Code Once you have the patient’s BMI, you will then have to consult a growth chart to assign the correct code. The charts are gender-specific, so make sure you consult a chart such as the ones the Centers for Disease Control and Prevention (CDC) have published for young males and females. For example, a 7-year-old boy measures 121.9 cm tall and weighs 22.9 kg. This equates to a BMI of 15.4, which the chart locates in between the 25th and 50th percentile for his age. Consequently, you can assign Z68.52 to the patient’s record when appropriate. Don’t Assign a BMI Code Unless BMI Is Documented Even though it is simple enough to calculate a patient’s BMI, you should avoid the temptation to do so on your own. “Many electronic medical records [EMRs] will now provide the calculation if the patient’s height and weight are documented. But I would not recommend assigning a BMI code if the BMI was not documented,” notes JoAnne M. Wolf, RHIT, CPC, CEMC, coding manager at Children’s Health Network in Minneapolis. Don’t Assign a BMI Code Unless the Patient Has an Associated Dx ICD-10 Guideline 1.C.21.c.3 states that the “BMI codes should only be assigned when there is an associated reportable diagnosis (such as obesity)” (emphasis retained). But remember: The guidance only affects the ICD-10 BMI codes, and not reporting the actual BMI itself (read on to find out when and why this should happen). Don’t Assume BMI Equates to a Dx “There may be times that a patient has a high BMI but is not considered overweight or obese, as is the case with some athletes due to muscularity,” cautions Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/ auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. Consequently, you should not correspond a low- or high-percentile BMI with a diagnosis such as R63.6 (Underweight) or E66.- (Overweight and obesity). Instead, “you should only code a diagnosis that the provider has actually documented in the medical record,” Wolf recommends. Remember: If your pediatrician does document either a R63.6 or E66.- diagnosis, you must follow the instructions for those codes, which tell you to “use [an] additional code to identify body mass index (BMI) if known.” Do Know Who Can Document BMI The good thing about BMI codes, however, is that you can assign them based “on medical documentation from clinicians who are not the patient’s provider … since this information is typically documented by other clinicians involved in the care of the patient (eg. a dietitian often documents the BMI …)” per ICD-10 Guideline 1.B.14. So, you don’t have to rely solely on your pediatrician’s documentation before assigning the code. Do Document BMI for Normal Percentiles Even though you won’t assign a BMI code for a patient without a diagnosis, a pediatric patient’s BMI should still be documented periodically, especially at every 99381-99396 (Initial/periodic comprehensive preventive medicine evaluation/ reevaluation and management of an individual including an age and gender appropriate history, examination …) encounter as part of the patient’s exam. Such documentation enables your pediatrician to monitor a child’s growth over time and give them a baseline by which deviations can be measured.
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