Wiki E65 for Obesity DX

[ch0507449@gmail.com]

Hello, I have a provider who is consistently using Localized adiposity: E65 for their "central obesity" dx. These include people with BMIs ranging from 29+ (currently coding for a 37, and yes, she did dx a BMI 29 with obesity instead as overweight).

My question is if this could affect anything on the billing side? I work for a health clinic under a hospital, and we are encouraged not to bother the providers unless absolutely necessary, so if this doesn't pose any potential problems then I will just leave it as is!

Thanks for your help!

 

[TThivierge]

Hi Ch05
Thus, it is ok (E65) but I feel the better dx would be E66.01...or E66.2. Plus must add the Z68 dx per BMI%. Also if exercise and diet discussed add at end dx Z71.3. If pt has chronic conditions add this too .The dx E66 is rated HCC 22 and RX HCC 43 but no HCC rating for dx. E65. The HCC disease groups helps conversion calculation factors & payments made per age and other diseases patient suffers. Dx E65 is for fat in one area not overall body. E65 dx can be added to any dx stream if pt grossly overweight in stomach area which can affecting labs and other illnesses or x-rays or just health complications. This is not my 2 cents but from my experience and taken from book Risk Adjustment Documentation & Coding by Sherri Bernard,CPC CCS.
Have a good day and I hope helped you!
Lady T

 

[LisaAlonso23]

Technically, we are to code based on the documentation and not providers' coding. It's worth educating the provider to ensure accurate communication via the patients' records. I would suggest they solely document the condition and not provide any codes to avoid this confusion.