BMI documented by doc

jennifer_desjardins_52048

I had a CDI consultant direct me to query a physician to document a BMI that was in a patient's current record. I was told as long as the physician documents this it ok to code, despite the fact that a supporting diagnosis or documented care is not in the chart. He stated that it is a V code and it ok to do this. The BMI was 18.3, and the patient would be considered underweight. I am getting pushback from the coders about coding this, and the consultant maintains this ok to code. Opinion? Educated opinions?

m.leblanc

I am in the bus but there Is a coding clinic that states the BMI is coded (can be taken from other documentation like nutritionist) as long as the provider documents a corresponding diagnosis in the medical record. Underweight is a medical diagnosis associated with a low BMI. Since the low BMI ( On Sep 26, 2014, at 10:25 AM, CDI Talk wrote:

I had a CDI consultant direct me to query a physician to document a BMI that was in a patient's current record. I was told as long as the physician documents this it ok to code, despite the fact that a supporting diagnosis or documented care is not in the chart. He stated that it is a V code and it ok to do this. The BMI was 18.3, and the patient would be considered underweight. I am getting pushback from the coders about coding this, and the consultant maintains this ok to code. Opinion? Educated opinions?

cynthia.hudson@christushealth.org

I would query this as I would an abnormal lab or x-ray. I would look through assessment for cachexia, emaciated. Is there a nutritional consult? Sometimes the dietitian will document poor nutritional intake. A verbal query of just discussion with the MD might be warranted. It is a significant finding if this is far off the patient's baseline. Has there been a weight loss that will help you formulate a query with more than just the BMI? What are we doing about it and are we treating it?

I don't think things should just be coded because they exist or are there in the record. Is it really putting the patient at risk to the point that we are treating the condition or has this patient had this BMI her whole life. I would want more information. Our queries are becoming a permanent part of the medical record so we have to be careful here. Good Luck!

Syndi Hudson, RN, CCM
CDI Specialist
Christus Santa Rosa New Braunfels
600 North Union
New Braunfels, Texas 78130
cynthia.hudson@christushealth.org
830-643-6116 (Office)
830-643-5139 (Fax)

"I press on toward the goal to win the prize for which God has called me." Philippians 3:14

jennifer_desjardins_52048

Thank you! I was aware of the coding guidelines, was wondering if there was supporting documentation about the bmi being coded as I stated, by MD and standing by itself. I appreciate the feedback you have all give me.

evanspx@sutterhealth.org

The coders are correct and the consultant's advice is counter to the guidelines cited in these responses. (Coder's can't assign a BMI w/o corresponding condition noted by MD)...this is very BASIC coding knowledge - is your consultant a qualified and credentialed coder?

Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell:  415.412.9421
evanspx@sutterhealth.org

jennifer_desjardins_52048

The coders were not assuming it. The BMI was on the chart. I was instructed to query doc to document bmi. He did.

jennifer_desjardins_52048

The coders are the ones who are telling me this is wrong. They know the guidelines. Just frustrated by different teaching. We hired a company to help start a CDI program, they have sent three different people out here to train me, all have different ways of doing things.

evanspx@sutterhealth.org

Understood - I am not saying the coders assumed anything. I am saying the advice from the consultant is fundamentally incorrect.

Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell:  415.412.9421
evanspx@sutterhealth.org

cnolan@swgeneral.com

Curious; would you mind telling me the Consulting Co you hired; we have the same issues.
If you want send private email: cnolan@swgeneral.com

evanspx@sutterhealth.org

Understood...that is frustrating. However, If you are getting conflicting advice from 3 consultants working for the same firm.....problem.

Advanced knowledge of coding rules is as important as clinical knowledge.

Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell:  415.412.9421
evanspx@sutterhealth.org

deanne_wilk

I am a CDI consultant and coding is correct. You can not assign bmi without a diagnosis. Inform your consultants they are incorrect.

jennifer_desjardins_52048

Gotcha! Thanks!

ddouthit

Did the physician document a corresponding diagnosis for the decreased BMI? i.e. Malnutrition, weight loss, cachexia, failure to thrive. Per coding guidelines, in order to capture a BMI there must be an associated diagnosis. We occasionally will see an elevated BMI or underweight BMI with no corresponding diagnosis and query for corresponding diagnosis.

Per coding clinic Second Quarter 2010:

Question:

There has been some confusion as to whether nursing staff documentation is acceptable for assigning the body mass index (BMI). Since hospitals are allowed to code the BMI based on the dietitian's documentation, it would seem reasonable to assign the BMI based on the nurse's documentation as well. Can coders use nursing documentation to assign the BMI?

Answer:

Yes, the BMI may be assigned based on medical record documentation from clinicians, including nurses and dietitians who are not the patient's provider. As stated in the Official Guidelines for Coding and Reporting, BMI code assignment may be based on medical record documentation from clinicians who are not the patient's provider, since this information is typically documented by other clinicians involved in the care of the patient. Dietitians were only mentioned as an example of a clinician that might document BMI information.

However, the associated diagnosis (such as overweight, obesity, or underweight) must be documented by the provider.

Refer to the Official Guidelines for Coding and Reporting for additional discussion.

Dorie Douthit RHIT,CCS
AHIMA-Approved ICD-10-CM/PCS Trainer
ddouthit@stmarysathens.org

jennifer_desjardins_52048

No, he didn’t. I was being observed by a consultant who instructed me to check BMI. I found it in the chart and he said I could query the doc to document just the BMI and that it would count as a CC, just because the doc documented, and that it didn’t need supporting dx or documentation. I have emailed him about it this afternoon after speaking to the coders. He maintains that because it is a v code it is fine to do this.

From: CDI Talk [mailto:cdi_talk@hcprotalk.com]
Sent: Friday, September 26, 2014 2:59 PM
To: Jennifer DesJardins
Subject: RE: [cdi_talk] BMI documented by doc


Did the physician document a corresponding diagnosis for the decreased BMI? i.e. Malnutrition, weight loss, cachexia, failure to thrive. Per coding guidelines, in order to capture a BMI there must be an associated diagnosis. We occasionally will see an elevated BMI or underweight BMI with no corresponding diagnosis and query for corresponding diagnosis.

Per coding clinic Second Quarter 2010:

Question:

There has been some confusion as to whether nursing staff documentation is acceptable for assigning the body mass index (BMI). Since hospitals are allowed to code the BMI based on the dietitian's documentation, it would seem reasonable to assign the BMI based on the nurse's documentation as well. Can coders use nursing documentation to assign the BMI?

Answer:

Yes, the BMI may be assigned based on medical record documentation from clinicians, including nurses and dietitians who are not the patient's provider. As stated in the Official Guidelines for Coding and Reporting, BMI code assignment may be based on medical record documentation from clinicians who are not the patient's provider, since this information is typically documented by other clinicians involved in the care of the patient. Dietitians were only mentioned as an example of a clinician that might document BMI information.

However, the associated diagnosis (such as overweight, obesity, or underweight) must be documented by the provider.

Refer to the Official Guidelines for Coding and Reporting for additional discussion.

Dorie Douthit RHIT,CCS
AHIMA-Approved ICD-10-CM/PCS Trainer
ddouthit@stmarysathens.org

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Copyright 2013

HCPro, Inc., 75 Sylvan Street, Danvers MA 01923

ddouthit

He is incorrect. I would send him copy of coding clinic. Per coding clinic, there MUST be an associated diagnosis. So sorry you are getting conflicting guidance. I imagine it becomes very confusing.

Dorie Douthit RHIT,CCS
AHIMA-Approved ICD-10-CM/PCS Trainer
ddouthit@stmarysathens.org

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Copyright 2013

HCPro, Inc., 75 Sylvan Street, Danvers MA 01923

evanspx@sutterhealth.org

I agree 100% with Dorie and all of the others offering opinion for this topic while citing official advice found in the Guidelines and Coding Clinic.

Paul Evans, RHIA, CCS, CCS-P, CCDS
Manager, Regional Clinical Documentation & Coding Integrity
Sutter West Bay
633 Folsom St., 7th Floor, Office 7-044
San Francisco, CA 94107
Cell: 415.412.9421
evanspx@sutterhealth.org

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Copyright 2013

HCPro, Inc., 75 Sylvan Street, Danvers MA 01923