Wiki Morbid obesity BMI primary?

[zy.ivey]

I have a doctor that insists the BMI v codes must be primary in order for his claims to process. He is adamant that if not his claims will deny. He believes that insurances will not pay obesity codes 278.XX. I know the BMI codes are not primary codes and that insurance will in fact pay the 278.XX codes because i have billed them for a different provider. Does anybody have links to websites that i can show him that the BMI codes are not primary. I have done research and mine is not good enough. So if you could please help i would appreciate it.

 

[rlh27]

I don't know if this is what you already showed him, but the guidelines say to use it as a supplementary code:

19 Supplementary Classification of Factors Influencing Health Status and Contact with Health Services (V01 - V91.99)


This classification is provided to deal with occasions when circumstances other than a disease or injury classifiable to categories 001-999 (the main part of ICD) are recorded as "diagnoses" or "problems." This can arise mainly in three ways:

a) When a person who is not currently sick encounters the health services for some specific purpose, such as to act as a donor of an organ or tissue, to receive prophylactic vaccination, or to discuss a problem which is in itself not a disease or injury. This will be a fairly rare occurrence among hospital inpatients, but will be relatively more common among hospital outpatients and patients of family practitioners, health clinics, etc.

b) When a person with a known disease or injury, whether it is current or resolving, encounters the health care system for a specific treatment of that disease or injury (e.g., dialysis for renal disease; chemotherapy for malignancy; cast change).

c) When some circumstance or problem is present which influences the person's health status but is not in itself a current illness or injury. Such factors may be elicited during population surveys, when the person may or may not be currently sick, or be recorded as an additional factor to be borne in mind when the person is receiving care for some current illness or injury classifiable to categories 001-999.


In the latter circumstances the V code should be used only as a supplementary code and should not be the one selected for use in primary, single cause tabulations. Examples of these circumstances are a personal history of certain diseases, or a person with an artificial heart valve in situ.

 

[mitchellde]

Not all V codes are supplemental codes some are in fact first listed only allowed. The chapter is a supplemental chapter meaning it was added in 1978 to the existing ICD-9 code set.
However if you look at the V85 codes in the code book they state to code first the appropriate obesity code. My book states:

V85.-are considered unacceptable as a principal diagnoses as it describes a circumstance which influences an individual's health status but not a current illness or injury, or the diagnosis may not be a specific manifestation but may be due to an underlying cause.

 

[zy.ivey]

Thank you

Thank you for the quick reply and i will show him this and see if it helps any. I explained to him that some V codes could be primary, but the codes for BMI are not in the allowed group.

 

[talumb@yahoo.com]

Obesity vs BMI as primary

Does anyone know where I can find the guidelines for coding obesity? My providers are using BMI as a primary code and sometimes obesity as secondary code? I Can't find documentation stating BMI should be secondary? Any suggestions?

 

[CodingKing]

Does anyone know where I can find the guidelines for coding obesity? My providers are using BMI as a primary code and sometimes obesity as secondary code? I Can't find documentation stating BMI should be secondary? Any suggestions?

ICD-10-CM guidelines is where this information can be found.

https://www.cms.gov/medicare/coding/icd10/downloads/2016-icd-10-cm-guidelines.pdf

Section I.B.14

Second paragraph:

The BMI codes should only be reported as secondary diagnoses.