Pediatric Coding Alert

Yes, even pediatric patients can reach the ‘morbid’ category.

In the not-too-distant past, some payers didn’t allow obesity codes as pediatric diagnoses—but that is changing, as pediatricians address obese patients for a variety of diagnoses, management situations, and counseling issues. However, just as many practices were getting accustomed to the ICD-9 codes for this condition, the system changed over to ICD-10 and coders are confused yet again. Read on to determine how to report obesity diagnoses in your practice.

According to the United States National Institutes of Health (NIH), the term “morbid obesity” means 50 to 100-percent (or 100 pounds) above one’s ideal body weight, which normally means a person with a body mass index (BMI) of 40 or greater. Obesity, on the other hand, refers to a patient who has a BMI of 30 to 39.9. Although morbid obesity is not particularly common among pediatric patients, practices do see cases of this diagnosis and should know how to code them.

You’ll find a direct crosswalk from ICD-9 (278.01, Morbid obesity) to ICD-10 (E66.01, Morbid [severe] obesity due to excess calories). But you can see that ICD-10 provides some additional clinical information about the condition’s cause.

You should look for physician documentation about caloric intake to help distinguish E66.01 from other obesity causes such as the following:

• E66.1 -- Drug-induced obesity (which doesn’t have an ICD-9 counterpart)
• E66.2 -- Morbid (severe) obesity with alveolar hypoventilation (which parallels ICD-9 code 278.03, Obesity hypoventilation syndrome).

Look for ‘Other’ Code

If your physician doesn’t provide specific information about the patient’s obesity, you had an “unspecified” code in ICD-9 (278.00, Obesity, unspecified) which now crosswalks to ICD-10 (E66.9, Obesity, unspecified).

But if your physician provides diagnostic information that doesn’t fit any specific code, you’ll have a way to report it in ICD-10 that you don’t have in ICD-9: E66.8 (Other obesity).

Exception: When the patient’s increased weight is due to a medical condition, such as adiposogenital dystrophy (E23.6) or obesity of endocrine origin (E34.9), you should report the underlying condition instead of morbid obesity.