Wiki Obesity-Non covered

[ahonkomp]

Hello Fellow Coders,

We have issues with insurance covering the diagnosis of obesity. I have a patient who is coming in to get a prescription for Phentermine and is coming back monthly for weight check/follow up. The physician says it is a controlled substance/stimulant that he will only give the patient for 3 months to "jump start" his weight loss. I feel the proper diagnosis IS obesity. I don't feel comfortable changing nor do I know what to change to.....I considered V58.69 but I wouldn't consider this "long term" use. Any similar experiences? Do you find any way around this to get this covered for the patient?

Thanks in advance!!

 

[teresabug]

I see your provider not wanting a patient to be "responsible" for an ov, really who does, but you cannot assign a payable dx code on a claim EVER just to "get it paid"; if the pt is on meds due to obesity, then obesity is the dx you have to report. If the insurance denies then you bill the patient. Coding any other way is fraud. If your provider is audited it will not be pleasant.

 

[ahonkomp]

Thanks for your reply! I completely agree with what you are saying and just needed reaffirmation. This doesn't make for happy patients but is compliant coding.

 

[teresabug]

way to stand your ground Amber