Morbid Obesity

jillian.bisbejillian.bisbe
in Clinical & Coding

Thoughts on capturing or querying for Morbid Obesity w/ BMI 35-39.9 w/ comorbidities (sleep apnea, DM, HTN, etc)?

In the past our facility has not captured Morbid Obesity unless BMI >40. I'm wondering if we are missing opportunities, especially as Morbid Obesity is an HCC.

Thanks!

Comments

  • MarceyLogsden1MarceyLogsden1
    I was thinking about this also, can't wait to see what peeps have to say....
  • 2140312121403121
    Interesting this was mentioned today. We just recently had a case of a patient with BMI of 34.9 and coding took the code for M.O. CDI questioned it, but the answer was since the pt. had HTN being treated AND it was so close to 40, AND the Dr. said it, they coded it. Captured as CC. We discussed as a group and await to see if it shows up in future coding cases. In this case it did not affect the DRG, but of course we want to accurately reflect the patient stay regardless. I too am anxious to see other comments.
  • bbogda@morrishospital.orgbbogda@morrishospital.org
    edited October 2017

    21403121...   How do you get a cc out of that?  What is the ICD-10 code?


  • 2140312121403121
    They coded it to E66.01---Morbid (severe) obesity due to excess calories. As I am looking back at the record, they did not pick it up as a cc, but they did code it as a diagnosis when to CDI it was not MO d/t the < BMI. Sorry for the confusion about the CC., my error.  We have noticed some recent uptick on the question about MO/Obesity/BMI overall. How about others?
  • katysuegood@gmail.comkatysuegood@gmail.com

    on the IP side, the CC is tied to the BMI code, so while there are clinical references (NIH) that support morbid (severe) obesity as being an appropriate dx for a patient with a BMI>35 with related conditions, it will not give you a CC. However, for HCC capture (for those which are also concerned with HCC's), the HCC will be captured if EITHER a BMI>40 OR Morbid (severe) obesity is coded. So from that perspective, capture of the documentation of Morbid obesity in these cases, would be valuable.


    Katy

  • proddy@clarionhospital.orgproddy@clarionhospital.org
    So, then are you all querying for a diagnosis of  Obesity for BMI between 35-39.9 also, or just when there are the comorbidities (sleep apnea, DM, HTN, etc).  I may have missed something, but didn't realize that the presence of comorbid conditions would affect obesity classification from just obesity vs morbid obesity.  thanks!
  • katysuegood@gmail.comkatysuegood@gmail.com

    It would depend on the focus of your program. If you are interested in HCC capture, it would be in your best interest to capture those patients that have a BMI between 35 and 40 with related conditions as Severe/Morbid obesity. If you are CC/MCC focused, it would not. I am just explaining an additional reason why I think that there is more discussion about BMI, especially those patients with BMI between 35-40.

    And yes, there are clinical references that support severe obesity as being either BMI >40 or BMI>35 with related comorbidities. NIH uses this definition. I believe Cleveland clinic, etc...

    https://www.nhlbi.nih.gov/files/docs/guidelines/prctgd_c.pdf


    Katy

  • lprescott1lprescott1

    Speak to your dietitians and develop diagnostic criteria for morbid obesity just like you have for malnutrition. This will allow you to think beyond just the BMI.


    Morbid Obesity     is a Serious Health Condition. ... An individual is considered morbidly obese if he or she is 100 pounds over his/her ideal body weight, has a BMI of 40 or more, or 35 or more and experiencing obesity-related health conditions, such as high blood pressure or diabetes.

    Obesity is frequently subdivided into categories:

    • Class 1: BMI of 30 to < 35
    • Class 2: BMI of 35 to < 40
    • Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity.
    Note: At an individual level, BMI can be used as a screening tool but is not diagnostic of the body fatness or the health of an individual. A trained healthcare provider should perform appropriate health assessments in order to evaluate an individual's health status and risks.  https://www.cdc.gov/obesity/adult/defining.htm
    https://www.nhlbi.nih.gov/health/health-topics/topics/obe/causes
    http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/endocrinology/obesity/


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