Wiki Billing for Office Visits with Only Dx Obesity-- Denied by Insurances

[amwittler]

We have pts who come in to see either their family provider or GYN provider for medications for weight loss. They are specifically making the appointments for weight management. A lot of our patients come in with no other conditions discussed at the visit. Some of the patients have no other chronic conditions. What is the suggested work flow for these visits because a majority of these are being denied by insurance because they have obesity as the dx on them? We are billing office visit charges out (99213 or 99214).

 

[CBLENNIE]

It sounds like the majority of these patients have plans that exclude treatment for weight loss or weight control. The insurance company I work for has the following standard exclusion in our ACA individual plans, which the majority of our employer sponsored plans also have. Do the EOBs or remittance documents you receive from the insurance companies indicate that the services are not a covered benefit under the patient's health plan?

For weight loss or weight control. For reversals or revisions of Surgery for obesity, except when required to correct an immediately life-endangering condition.​

If your office isn't already doing so I would recommend you start checking the patient's insurance plan benefits for these office visits prior to their appointments so that when they come in for the visit you can collect payment for those who have plans that exclude these visits. That way you aren't struggling to collect the cost of the visit from the patient.

 

[SDargaj]

Are they ONLY getting med refills?

 

[amwittler]

Are they ONLY getting med refills?

They typically go over how they are doing with the medication and document weight and blood pressure and then go over a plan (determine if it is appropriate to refill med or not).

 

[Cynthia Hughes]

We have pts who come in to see either their family provider or GYN provider for medications for weight loss. They are specifically making the appointments for weight management. A lot of our patients come in with no other conditions discussed at the visit. Some of the patients have no other chronic conditions. What is the suggested work flow for these visits because a majority of these are being denied by insurance because they have obesity as the dx on them? We are billing office visit charges out (99213 or 99214).

When the only diagnosis is obesity, I recommend that the practice review the health plans covered preventive services for addressing risks related to obesity and develop policies and procedures for scheduling, providing, and reporting these preventive services.This is usually not billed with office visit codes and may require a specific type of visit (eg, use of the 5 A's; assess, advise, agree, assist, and arrange) with reporting of preventive medicine counseling codes or HCPS codes for face-to-face behavioral counseling for obesity. Not only are these services covered, they are covered without out-of-pocket cost to the patient.

Note that most are time-based so time must be documented. Also, prescribed weight loss drugs may be non-covered when the patient has no comorbid condition.

I hope that helps.
Cindy

 

[danielle0419]

We have pts who come in to see either their family provider or GYN provider for medications for weight loss. They are specifically making the appointments for weight management. A lot of our patients come in with no other conditions discussed at the visit. Some of the patients have no other chronic conditions. What is the suggested work flow for these visits because a majority of these are being denied by insurance because they have obesity as the dx on them? We are billing office visit charges out (99213 or 99214).

We have pts who come in to see either their family provider or GYN provider for medications for weight loss. They are specifically making the appointments for weight management. A lot of our patients come in with no other conditions discussed at the visit. Some of the patients have no other chronic conditions. What is the suggested work flow for these visits because a majority of these are being denied by insurance because they have obesity as the dx on them? We are billing office visit charges out (99213 or 99214).

When we have patient come in who take Ozempic for weight Managment. They use Z51.81 as primary dx and obesity and bmi following. (For patients taking Ozempic, regular monitoring of blood sugar levels is important to ensure proper treatment)

 

[michrpree@yahoo.com]

We have pts who come in to see either their family provider or GYN provider for medications for weight loss. They are specifically making the appointments for weight management. A lot of our patients come in with no other conditions discussed at the visit. Some of the patients have no other chronic conditions. What is the suggested work flow for these visits because a majority of these are being denied by insurance because they have obesity as the dx on them? We are billing office visit charges out (99213 or 99214).

Did you code the BMI with the Obesity dx?

 

[amwittler]

Did you code the BMI with the Obesity dx?

yes we do. I always make sure that BMI is not the only listed dx or the primary dx