BMI and Gastric Surgery

christine.butka@hmhn.org

Our hospital does not review pediatric charts, however the Coding Manager is asking for help with getting the Bariatric Surgeons to document the BMI in pediatric patients as a percentile.  Our Bariatric Physicians have never heard this before and are giving us pushback especially on those patient who are older that 18.  Does any facility review / code pediatric bariatric charts?  Can anyone point me to resources, literature etc on the subject so we can educate the surgeons?  Does any facility allow the coders to plot the BMI on the CDC growth chart to determine the percentile or does the surgeon have to document the percentile in order for it to be coded.  If we don't code the percentile because we do not know or we cannot get the surgeon to answer, do we risk not being reimbursed?  Thank you.

Christine Butka RN MSN CDI Manager

Centrastate Medical Center

Freehold NJ

vparent@emhs.org

We currently use cerner and it is a requirement to have the height and weight entered into the system before any physician ordering can take place.  The software automatically calculates the BMI. BUT, we still need a nutritional diagnosis from the attending physician in order to code the BMI.

vbica@nemours.org

We do review for documentation for our bariatric medical and surgical children.  All of our BMI calculations yield the bmi-for-age percentile from the CDC BMI for age growth chart.  >95%ile is considered obesity and >99%ile is considered morbid/severe obesity.

From the CDC Division of Nutrition:

In 2004, an expert committee (Barlow, 2007) comprised of representatives from 15 national health care organizations was convened and charged with revising the 1998 recommendations on the evaluation and treatment of child and youth obesity (Barlow and Dietz, 1998). The expert committee recommended classifying BMI at the 85th to 95th percentiles for age and sex to identify children or teens who are overweight, and a BMI greater than or equal to the 95th percentile to identify children or teens who are obese (Barlow, 2007). These cut points are unchanged from the 1998 expert committee recommendations (Barlow and Dietz, 1998).

    The rationale for the use of these criteria is that a BMI at the 95th percentile in the U.S. population corresponds to a BMI of 30 in a young adult. In a young adult, a BMI greater than or equal to 30 is considered obesity.
    A BMI at the 85th percentile in a young adult identifies a young adult with a BMI of 25, which is considered at the top end of a healthy weight classification.
    Therefore, the criterion used for children and teens corresponds (roughly) to the criteria used for adults to identify overweight and obesity.

The cutoff for underweight of less than the 5th percentile of BMI-for-age is based on recommendations by the World Health Organization Expert Committee on Physical Status (World Health Organization, 1996).

All that said, we also base our diagnoses on the BMI Z score