Pediatric Coding Alert

Question: The payer rejects my claims using codes from the 278.00- 278.02 family for patients who are overweight, obese, or morbidly obese. What diagnoses should I report instead?

California Subscriber

Answer: Your payer might reject 278.00-278.02 (Overweight and obesity ...) because the codes represent non-covered diagnoses. Two possibilities for covered diagnoses include 783.1 (Abnormal weight gain) or the most accurate choice from V85.5x (Body Mass Index, pediatric), depending on the child's BMI.

Tip: Also code any underlying complications the patient might have. These might include benign hypertension (401.1, Essential hypertension; benign), fatigue (780.79, Other malaise and fatigue), shortness of breath (786.05), or diabetes (250.00, Diabetes mellitus without mention of complication; type II or unspecified type, not stated as uncontrolled).

Some payers don't allow the obesity codes as pediatric diagnoses. Check with the insurance company to see if your contract carves out these types of diagnoses.