Supporting data for BMI

dsmith12h@aol.com

I have had many charts coded lately where the coder has not coded a BMI>40 when it is documented in the progress notes with the diagnosis of morbid obesity. They tell us it does not meet criteria for other diagnoses. We have dietary consult to calculate the BMI but they usually don't counsel-- they tell us it is done as outpatient. Example of documtation for one chart showed-- cc: SOB, Imp: CHF, (SOB multifactorial- obesity hyperventilation syndrome, PHTN, CHF. Obesity-special bed, diet: Low fat, low cal).

What type of data is acceptable for coding BMI? I know the guideline for other diagnoses, but what specific evaluations, treatments, or procedures do you capture or query for? What data shows extended LOS? I know what to look for with increased nursing care and monitoring but our coders don't always look at nurses documentation and previous attempts to educate the nurses haven't been successful in getting the documentation consistantly on the chart.

Your help and/or advise with this would be greatly appreciated.

Thanks, Debbie

Unknown

I've included on my morbid obesity query to include, "Do you feel that additional resources may have been used (increased nursing care, affected surgery time or difficulty, increased risk or co-morbidities, nutritional care, etc." Sometimes, when I see a BMI over 40, I'll track down the nurse taking care of the patient and do some quick education and ask them to document any special care involved....a perfect progress nursing note would help appeal an insurance denial....."took 3 nurses to do a dressing change," The surgeons are the best when they include in their operative report...."because of patient's obesity, surgery time longer than usual" or "bigger incision made due to morbid obesity." If the chart has absolutely no reflection of how the BMI may have affected patients care, it is not codable. Maybe you could make a note on your CDS sheet the nursing documentation that proves increased nursing care, etc.

dsmith12h@aol.com

I can always count on good advise from CDI talk-- It helps ease frustration. Thanks you so much for your response.