Pediatric Coding Alert

Question: How will the new ICD-10-CM codes for childhood obesity, which became effective October 1, 2024, improve diagnosis and treatment for children and adolescents? What are some of those codes?

North Carolina Subscriber

Answer: Obesity is a complex, chronic condition that significantly impacts health, increases medical costs, and lowers quality of life, especially in children. The previous ICD-10-CM codes did not fully capture the varying levels of obesity severity, leading to gaps in treatment and underreporting in medical data. The new codes, which follow updated clinical guidelines, provide a more accurate, detailed classification of obesity based on age, gender, severity, and related complications, ensuring better diagnosis and intervention for both children and adults.

Starting Oct. 1, 2024, new ICD-10-CM codes for childhood obesity reflect updated guidelines from organizations like the American Academy of Pediatrics. These codes aim to reduce under-coding, enhance claims data, and improve understanding of medical costs related to obesity. They also aim to reduce stigma and support a more inclusive environment for patients. For example, healthcare providers are encouraged to use terms like “Class 3 Obesity” instead of “morbid obesity due to excess calories,” fostering a more supportive and respectful patient-provider relationship.

The descriptors for new E codes have “Use additional” code instructions to use new childhood Z codes for better treatment options. In pediatrics, obesity is now classified into three classes based on body mass index (BMI) percentiles, which is reflected by the Z codes. Here are some of the codes:

• E66.811 (Obesity, class 1)
• E66.812 (Obesity, class 2)
• E66.813 (Obesity, class 3)
• Z68.54 (Body mass index [BMI] pediatric, 95th percentile for age to less than 120% of the 95th percentile for age)
• Z68.55 (Body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age)
• Z68.56 (Body mass index [BMI] pediatric, greater than or equal to 140% of the 95th percentile for age)

These classifications help guide the intensity of treatment and intervention needed. Treatment for pediatric obesity varies by severity and may include focusing on lifestyle changes, including healthy eating, physical activity, and behavioral therapy, with regular monitoring; it also may involve more intensive therapy, including frequent counseling, possible medication, and family-based programs; or the treatment may require a multidisciplinary approach with intensive interventions and ongoing health monitoring.

In all cases, the approach should be individualized and involve close monitoring of the child’s physical and emotional well-being.

For obesity code claim submission, see the table below. Code category E66 (Overweight and Obesity) first, then use an additional code category Z68 (Body Mass Index [BMI]) for children 2-19 years old.

The new codes are a significant step in improving obesity care, helping healthcare providers deliver accurate diagnosis and effective treatment for patients of all ages.

Donna Walaszek, CCS-P, Northampton Area Pediatrics, Northampton, Massachusetts