Wiki Morbid Obesity in Orthopaedics

[MMadrigal]

I would like other's opinions on this board, before I take this to my doc. If he has a new patient who was diagnosed with 715.16 Osteoarthritis of her knee. Patient has a body mass index of 52. He mentions "Weight loss" in this "PLAN", as well as under "Activity"
Should we be adding ICD's 278.01 Morbid Obesity and V85.43 BMI 50.0 - 59.9, Adult to our claim. I would love to hear your thoughts. Kindest regards, Mary mmadrigal@hawaii.rr.com

 

[qedwards]

Coding to the highest level of specifity is critical. The "0fficial Guidelines of ICD-9-CM Coding " Section IV K. Code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care treatment or management. Reporting the morbid obesity if documented and BMI, support the need for the plan as documented. Also demonstrates the additional risk in taking on the patient condition of osteoarthrosis. It is extremely important with surgical cases. This co-condition definately has the potential for adverse outcome of surgery. Diabetes, Obesity, ESRD, and Tobacco use are conditions that will impact most orthopaedic treatments / plans. Taking care to properly report co-conditions / morbidities is important if documented in ther record. As most often will have the potential to impact plan of care and or increase the risk of adverse outcome of treatment. Hope this helps!

 

[Christine LaBelle]

My doctors seldom code out obesity on their E&M's, but if the patients go for surgery they add the comorbidity and also modify with 22 (and increase their fee) since they know the surgery is more difficult and the post op will be compromised as well.

 

[Treetoad]

Be careful when using modifier 22. Morbid obesity in itself doesn't automatically render a service more difficult. The documentation needs to specifically indicate how the procedure was more difficult/more time consuming. Without this information, adding a modifier and increasing the fee won't matter.