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Wiki GUIDELINE FOR CLASSES OF OBESITY
- Thread starter NJennings
- Start date
CBLENNIE
Expert
I don't think you can actually assign a code based on the provider's documentation since there isn't an ICD-10 code that corresponds to the class of obesity. I did find this little tidbit from the CDC's website in an article titled Defining Adult Overweight & Obesity.
Does your provider document the BMI anywhere in the chart and do you need the BMI for your claim to be processed by the payer? If the BMI is not documented and you need it for your claim you probably need to query the provider. If the patient has an MA plan it is likely important that the BMI be included because of Risk Adjustment scoring, which may impact your provider's reimbursement from the MA plan as the MA plan needs it for reimbursement from CMS for covering the MA patient.
Does your provider document the BMI anywhere in the chart and do you need the BMI for your claim to be processed by the payer? If the BMI is not documented and you need it for your claim you probably need to query the provider. If the patient has an MA plan it is likely important that the BMI be included because of Risk Adjustment scoring, which may impact your provider's reimbursement from the MA plan as the MA plan needs it for reimbursement from CMS for covering the MA patient.
They do typically document the BMI. Our medical director wants to steer away from the " morbid" and wants to use the clasess. I agree with you, the coder can not code base on the class. This company deals with medicare and medicaid insurance.
CBLENNIE
Expert
Well then, your medical director is going to have to get over their issue with using "morbid" to describe the level obesity because for now that is how ICD-10 is setup and so you need the records to reflect the proper level of specificity for the patient's obesity. Unless they would prefer that you not code the type of obesity which could affect any reimbursement arrangements they have with respect to risk adjustment on MA plan patients. Until the healthcare industry as a whole decides to move to using classes of obesity you are limited to the current coding conventions which use the term "morbid" when applicable.