Obesity is one of the leading preventable causes of morbidity and mortality in the United States. According to the Center for Disease Control and Prevention (CDC) more than 60 percent of adults in the U.S. are overweight and more than 30 percent are obese. Approximately 15 percent of children under 19 are considered overweight. Most authorities view it as one of the most serious public health problems we have today, and it continues to be on the rise. Because the incidence of obesity needs to be tracked and because obesity coding has some medial necessity and Hospital Acquired Condition (HAC) implications, it is important that coders be aware of the coding requirements.
Obesity is a condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health and reduced life expectancy. Being overweight or obese increases the risk of many diseases and health conditions such as hypertension, heart disease, type 2 diabetes, stroke and sleep disorders. Adult obesity is most commonly caused by a combination of eating too many calories and lack of physical activity, and in some instances genetics or medications. The increased incidence of childhood obesity is linked to a number of reasons including a sedentary lifestyle, social and economic status and eating habits.
A person is generally considered overweight if they have a body mass index (BMI) between 25 and 29.9. Obesity is defined as a BMI of 30 or higher. A BMI over 40 or anyone greater than 100 lbs overweight is generally considered morbidly obese. It is important to note that BMI does not directly measure body fat. As a result, some people, such as athletes who are muscular, may have a BMI that identifies them as overweight even though they do not have excess body fat.
BMI measurements are used to categorize patients in a more specific manner than just using the terminology overweight or obese and is calculated based on height and weight. It can be determined by dividing a person’s weight in kilograms by their height in meters squared. It can also be calculated by multiplying a person’s weight in kilograms by 704.5, and dividing the result by their height in inches twice.
Coding Overweight and Obesity
Two codes are typically assigned to report overweight and obesity. A code from category 278.0, Overweight and obesity should be reported first and includes the following codes:
- 278.00, Obesity, unspecified
- 278.01, Morbid obesity
- 278.02, Overweight
A second code to report the BMI is assigned next. As mentioned above, the BMI codes are used to assist in distinguishing between overweight and obese patients. They also assist in identifying severity and potential health risks and outcomes. For persons over 20 years of age, one of the following BMI codes is assigned if documented:
- V85.2X, Body Mass Index between 25-29, adult
- V85.3X, Body Mass Index between 30-39, adult
- V85.4, Body Mass Index 40 and over, adult
For pediatric patients one of the following pediatric BMI codes is used instead:
- V85.53, Body Mass Index, pediatric, 85th percentile to less than 95th percentile for age
- V85.54, Body Mass Index, pediatric, greater than or equal to 95th percentile for age
BMI pediatric codes are assigned for person’s age 2-20 years of age. The percentiles are based on the growth charts published by the CDC. A child in the 85th to 95th percentile is considered at risk and corresponds to a BMI of 25. Children over the 95th percentile have the most severe level of childhood obesity, which corresponds to a BMI of 30.
There are no hard set weight ranges used as criteria for coding the diagnoses of overweight or obesity because everyone is different. These diagnoses are documented by the physician who takes the patient’s height and weight into consideration first. Only code the condition that is documented by the physician. If there is conflicting documentation, the attending provider should be queried for clarification.
Coders should not calculate the BMI. The BMI code assignment should be based on the documentation in the medical record, which may be included in a dietitian’s note. This is an exception to the guideline that requires code assignment be based on the documentation by the physician or any qualified healthcare practitioner who is legally accountable for establishing the patient’s diagnosis. While BMI may be reported using the dietitian’s documentation, the codes for overweight and obesity can only be based on the provider’s documentation. Only when the provider has specifically documented overweight, obesity or morbid obesity can the coder use the dietitian’s note to assign the appropriate BMI code from category V85.
For obstetric patients with obesity assign code 649.1X, Obesity, complicating pregnancy, childbirth or the puerperium, first followed by the appropriate obesity and BMI codes.
Review the following Coding Clinics for more information on coding overweight and obesity; 1st Quarter 1999, 4th Quarter 2001, 3rd Quarter 2003 and 4th Quarter 2004, 4th Quarter 2005, 2nd Quarter 2006, and 2nd Quarter 2009.
Test your knowledge on overweight and obesity coding with the following quiz:
1. A patient presents to the clinic for continued evaluation of sleep apnea. During the visit he is seen by a dietician for diet counseling. The dietician note indicates the patient is obese and has a BMI of 33. The physician lists the patient’s diagnosis as sleep apnea. What diagnoses codes should the facility assign for this clinic visit?
a. 780.57, 278.00, V85.33
b. 780.57, V85.33
d. 780.57, 278.00
2. A patient presents to the hospital for delivery. The physician documents that the patient has had a high risk pregnancy because of obesity and is admitted for induction of labor. The patient delivers her baby and before discharge is seen by a dietician who documents a post delivery BMI of 41. The diagnoses documented by the physician on discharge are; Delivered single newborn and pregnancy complicated by obesity. What diagnoses codes should be assigned for this case?
a. 649.11, 278.01, V85.4, V27.0
b. 649.11, 278.00, V85.4, V27.0
c. 650, V27.0
d. 649.12, 278.01, V85.4, V27.0
This month’s column has been prepared by Cheryl D’Amato, RHIT, CCS, director of HIM, facility solutions, and Melinda Stegman, MBA, CCS, clinical technical editor, Ingenix.
1. c. Code 780.57 is assigned to report the sleep apnea. In this instance codes for obesity and BMI are not assigned because the obesity is not substantiated in the medical record by the physician. The physician can be queried for clarification.
2. b. Code 649.11 is assigned as the principal diagnosis to report the delivery in a pregnancy complicated by obesity. Code 278.00, Obesity, is assigned next because even though the patient’s BMI is 41 the physician does not document morbid obesity. Code V85.4 indicates the BMI of 41. Code V27.0 may also be assigned to report the outcome of the delivery, single live born.