Calculating BMI for bilateral amputee

cmorell

Nursing calculated the BMI as 111.5 based on a height of 3ft 2in and a weight of 229 lbs. I tried to research this to gain some supporting documentation and found lots of material stating that BMI was not really used in this population, but then found this info on the Highmark Medicare Services site and felt it might be appropriate to apply it equally in the BMI instance. Would appreciate colleagues' thoughts. Thanks!

Reference: Highmark Medicare Services https://www.highmarkmedicareservices.com/index.html

1. How should the weight and height be reported on a dialysis claim? Should we use the most recent weight and height measurement, which may be from the prior month?
The weight and height of the dialysis patient is reported under value codes A8 (weight) and A9 (height). The weight of the patient should be measured in kilograms after the last dialysis session of the month. The height should be measured in centimeters, as the patient presents, during the last dialysis session of the month.

*****For the double-amputee patient, weight should be calculated using the following formula: pre-amputation weight = actual weight X 1.5. Height should be reported as pre-amputation height. Where feasible, this measurement may be obtained from Form 2728.
Reference: CMS Publication 100-04 Chapter 8 Section 20.1.1 and 50.3

robert.hodges2

I would recommend that you contact Nutrition Services for an accurate BMI in this case. We have a lot of amputee's here at the VA and I never use the one that is automatically calculated. If I have a question, I get with one of our registered dieticians and ask for their input. They have formulas and calculations they use for amputees and are a great resource. The bonus is that coders can use that BMI for coding. You just then need to get an appropriate diagnosis from the provider.

Robert

Robert S. Hodges, BSN, MSN, RN
Clinical Documentation Improvement Specialist
Aleda E. Lutz VAMC
Mail Code 136
1500 Weiss Street
Saginaw MI 48602
P: 989-497-2500 x13101
F: 989-321-4912
E: Robert.Hodges2@va.gov
 
"The difference between the right word and the almost right word is the difference between lightning and the lightning bug." Samuel "Mark Twain" Clemens

david.smith

I agree with Robert. We had some concerns with some of the automatic calculations (our med form has a calculated value for BMI). We met with Nutrition and they had some of the same concerns. At this point, we are using Nutrition's BMI calculation until there is some facility reconciliation process implemented. Nutrition is now documenting BMI in their progress note for all patients that they see.