AHA coding clinic (4th quarter 2018)-) These questions don't really answer all your questions, but might help. I'm a new risk adjustment coder, but it seems like who you are risk adjustment coding for depends on what is allowed.)
"The AHA Central Office has received many questions about assigning body mass index (BMI) codes. The following questions and answers are being published in response to many requests for assistance and to clear up any confusion.
Question 1:
Is there a list of
diagnosis codes that are associated with the body mass index (BMI) measurement codes? Can BMI codes be assigned without a corresponding documented diagnosis of overweight, obesity or morbid obesity from the provider?
Answer:
No, the provider must provide documentation of a clinical condition, such as overweight, obesity or morbid obesity, to justify reporting a code for the body mass index. As stated in the
Official Guidelines for Coding and Reporting, Section I.B.14, the associated diagnosis (such as overweight or obesity) must be documented by the patient’s provider. If the linkage between the BMI and a clinical condition is not clearly documented, query the provider for clarification. ICD-10-CM does not provide definitions or a list of
diagnosis codes associated with BMI.
Question 2:
If the provider documents obesity or morbid obesity in the history and physical and/or discharge summary only, without any additional documentation to support the clinical significance of this condition, can it be coded? There is no other documentation to support clinical significance for this condition such as evaluation, treatment, increased monitoring, or increased nursing care, etc.
Answer:
Obesity and morbid obesity are always clinically significant and reportable when documented by the provider. In addition, if documented, the body mass index (BMI) code may be coded in addition to the obesity or morbid obesity code.
Question 3:
If the provider documents “overweight” in the history and physical and/or discharge summary only, without additional documentation to support the clinical significance of this condition, can it be coded? There is no other documentation to support clinical significance. Can we also assign the BMI code?
Answer:
No, neither the code for overweight nor the BMI code is assigned if there is no documentation that the diagnosis of “overweight” meets the definition of a reportable secondary diagnosis. While “overweight” may place a patient at increased risk for certain medical conditions, it does not automatically meet the definition of a reportable diagnosis.
For inpatient reporting purposes, the definition for “other diagnoses” is interpreted as additional conditions that affect patient care in terms of requiring:
- clinical evaluation; or
- therapeutic treatment; or
- diagnostic procedures; or
- extended length of hospital stay; or
- increased nursing care and/or monitoring.
For outpatient reporting purposes, as stated in the
Official Guidelines for Coding and Reporting, Section IV.J. “Code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care treatment or management.”
Question 4:
Our hospital is receiving denials regarding the coding of BMI and some payors are requiring that it must meet the definition of reportable additional diagnosis and clinically validated regarding body mass. We have interpreted that to mean that something should be documented in the chart regarding weight loss, a special diet, a Hoyer lift, nutrition involved, something regarding loss or gain of weight, and advice to improve the situation revolving around weight. Other sample documentation we use to clinically validate include general weight loss/lifestyle modification strategies discussed (elicit support from others; identify saboteurs; non-food rewards, etc.), or informal exercise measures discussed, e.g., taking stairs instead of elevator. Would these be valid examples to warrant the reporting of BMI as a secondary diagnosis?
Answer:
BMI codes may be assigned whenever an associated diagnosis (such as overweight or obesity) is documented and meets the definition of a reportable diagnosis.
Question 5:
When a patient has a BMI below 40, but morbid obesity is documented by the anesthesiologist (no other documentation regarding the patient’s obesity is recorded in the health record), is it appropriate to code morbid obesity or is a query recommended?
Answer:
Codes for overweight, obesity or morbid obesity are assigned based on the provider’s documentation of these conditions. Therefore, if morbid obesity is documented, assign code
E66.01, Morbid (severe) obesity due to excess calories. While the BMI is used as a screening tool for patients who are overweight or obese, there is no coding rule that defines what BMI values correspond to obesity or morbid obesity, since the conditions are coded only when diagnosed and documented by the provider or another physician involved in the patient’s care.
As noted in the
Official Guidelines for Coding and Reporting, Section I.A.19, “The assignment of a
diagnosis code is based on the provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis.” Please refer to
Coding Clinic, Fourth Quarter 2016, pages
147-
149, for additional information regarding this guideline.
Documentation from physicians other than the attending physician (i.e., consultants, residents, anesthesiologists, etc.) is acceptable, as long as there is no conflicting information from the attending physician."
