RE: [EXTERNAL] RE:Morbid Obesity along with joint replacements
Although I agree with what everyone has said (and that our goal is to capture all conditions treated, evaluated, or monitored during the encounter) we have recently experienced some auditing woes related to the coding and billing of the diagnosis code of morbid obesity along with the BMI >40. The auditors share with us that yes, the patient *does* have a BMI > 40, however their "morbid obesity" didn't require any extra care and doesn't meet the definition of a secondary diagnosis. As I re-review these records in an attempt to keep this diagnosis, I find this is often true. For example - we assessed the patient for a BMI once prior to surgery.....and that's it. They were not weighed on a daily basis, there was no nutritional consult or nutritional education done, they were a 1-person assist after surgery and/or used a walker by themselves, there was no diabetes present, there was no bariatric bed ordered, and their length of stay was no longer than a person with a lower BMI. Compare that to another patient who definitely met criteria - weighed several times, bariatric bed ordered, extended LOS, etc. We're looking at two different patients (in my opinion!).
We have been getting hit a little hard with these over the last few months. Should our providers document according to auditors, and should we query according to auditors? Absolutely not. Is it our fault that morbid obesity is a CC (and sometimes the only one)? No.
I'm just sharing our experience and giving out a friendly warning to everyone to make sure that the MO/BMI meets the definition of secondary diagnosis. We are currently working on a standard order set in Epic to support the care that is given to these patients (and hopefully more beef for auditors to BACK OFF).
Rachel Mack, MSN, RN, CCDS, CDIP
Clinical Documentation Integrity Educator
CDI Supervisor - St. Vincent, St. James, & St. Francis
SCL Health - 12600 W. Colfax Suite A-250, Lakewood, CO 80215
rachel.mack@sclhs.net
303-403-7925
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We have been getting hit a little hard with these over the last few months. Should our providers document according to auditors, and should we query according to auditors? Absolutely not. Is it our fault that morbid obesity is a CC (and sometimes the only one)? No.
Rachel Mack, MSN, RN, CCDS, CDIP
Clinical Documentation Integrity Educator
CDI Supervisor - St. Vincent, St. James, & St. Francis
SCL Health - 12600 W. Colfax Suite A-250, Lakewood, CO 80215
rachel.mack@sclhs.net
303-403-7925
[cid:image001.jpg@01D02347.72DBEC10]