Morbid Obesity-Outpatient CDI

tracyaboldt@gmail.comtracyaboldt@gmail.com
in CDI Expansion
Within in a clinic note, "Morbid obesity w BMI of 40-49" is documented however no additional supporting documentation regarding an assessment/plan.  Would you code the HCC 22 including codes E6601 and Z6842 or would you require the provider to add additional documentation to support the plan/assessment of the Morbid Obesity w/BMI.  

Thanks,
Tracy Boldt RN BSN CCDS CDIP
System Manager Clinical Documentation Improvement Inpatient/Outpatient

Comments

  • lostwaterlostwater
    To code an outpatient diagnosis, it must be relevant for that encounter.  The HCC "profile" for the patient is the cumulative, non repetitive hierarchical total of all the diagnoses submitted through the year.  Unless it was assessed, treated, etc, I would advise querying the provider for significance before submitting the diagnosis on a claim.

    Mark
  • tmcneil@huntregional.orgtmcneil@huntregional.org
    I would report it per Coding Clinic 3rd Qt 2011 p3-4 which states the following:

    Question:

    If the provider documents obesity or morbid obesity in the history and physical and/or discharge summary only without any additional documentation to support clinical significance of this condition, can it be coded? There is no other documentation to support clinical significance such as evaluation, treatment, increased monitoring, or increased nursing care, etc., for this condition.

    Answer:

    Individuals who are overweight, obese or morbidly obese are at an increased risk for certain medical conditions when compared to persons of normal weight. Therefore, these conditions are always clinically significant and reportable when documented by the provider. In addition, the body mass index (BMI) code meets the requirement for clinical significance when obesity is documented. Refer to Coding Clinic, Third Quarter 2007, pages 13-14, for additional information on coding chronic conditions.

    Jennifer Cooper, MHIIM, RHIA, CDIP, CCS

  • BTC2018BTC2018
    Although not stated, the info in AHA CC 3Q 2011 pg 3-4 is for inpatient coding. It then refers to AHA CC 3Q 2007 pg 13-14 to see more about chronic conditions (morbid obesity would be a chronic condition). AHA CC 3Q 2007 then states when coding for OUTPT: 

                   I. Chronic diseases                      

     Chronic diseases treated on an ongoing basis may be coded and reported as many times as the patient receives treatment and care for the condition(s)

                        J. Code all documented conditions that coexist

                           Code all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care treatment or management. Do not code conditions that were previously treated and no longer exist. However, history codes (categories Z80-Z87) may be used as secondary codes if the historical condition or family history has an impact on current care or influences treatment.

  • lprescott1lprescott1
    On the clinical side, as a nurse- morbid obesity is always significant and I believe the Coding Clinic direction above supports reporting it.  but I do I hear from many that private payers are asking for more supportive documentation. I would encourage providers to not only state this (or any) diagnosis but also make comment to the significance and how it influenced care or patient communications etc.
  • Sharme.Brodie@hcpro.comSharme.Brodie@hcpro.com
    Per CC4Q2018 page 77- Obesity and morbid obesity are always clinically significant and reportable when documented by the provider. In addition, if documented, the body mass index (BMI) code may be coded in addition to the obesity or morbid obesity code.
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