Coding Clinic 4th Quarter 2018 BMI
How are you all interpreting the Coding Clinic regarding BMI? We have differing opinions in our organization and are trying to come to a consensus.
Are you interpreting this to mean - you can code the diagnosis (obesity, morbid obesity) BUT cannot report the BMI code unless it meets the definition of a secondary diagnosis (clinical evaluation, therapeutic treatment, diagnostic procedures, extended LOS, or increased nursing care/monitoring)?
Thanks!
Comments
No. Obesity is always clinically significant and should be coded if diagnosed/documented. If it is documented/captured, the BMI should also be captured.
When other conditions that would also allow capture of BMI (overweight, malnutrition, anorexia, etc) are documented, they must meet reportability prior to either the BMI or the underlying condition can be coded.
Katy
This is what Coding Clinic said to us on 10/26
This letter is in response to your request for clarification regarding obesity and BMI coding.
The Central Office has received many question about assigning BMI codes, therefore, updated advice was published in Coding Clinic Fourth Quarter 2018, pages 77-83. The advice clarifies that in order to assign a code for BMI, an associated clinical condition must be documented by the provider (i.e., morbid obesity, overweight, or obesity). It is not appropriate to assign a code for the BMI without an associated diagnosis. The advice further clarifies that obesity and morbid obesity are always clinically significant and reportable conditions that should be reported when documented by the provider.
I trust that this information will be of assistance to you.
Agree with what Katy just posted.
If the BMI is documented but the associated diagnosis (obesity, morbid obesity, etc.) is not documented and there is no evidence in the medical record that the obesity impacted the care of the patient, would it be appropriate to query for the associated diagnosis?
yes, as morbid obesity is always clinically significant.
Katy
Depends on the BMI and what the clinical circumstances were. In your question above, you did not say what the BMI was, only that it was documented. Generally I don't look for Obesity with BMI's less than 32 to 33ish and I don't look for morbid without BMI's above 34 to 35ish or with clear documentation the the significant weight is impacting one or more weight related health problems. Other definitions of morbid 100lbs over ideal body weight and or a BMI >40.
So, NOT a world champion body builder.
I would expect a BMI above 40 to be a cofounding factor in the severity of both hypertension and COPD.
Just to play devils advocate here with Laurie... With no other information to indicate whether the patient is/is not obese, I would query. This is where the provider needs to make the determination. The only time I would NOT query would be if there was clear indication that the BMI does NOT represent obesity. Body builder being one, amputations, etc...
Katy
Marjie
mlbuntze@texaschildrens.org
Not OB. I know you cannot code BMI with pregnancy any longer. We were really confused on this part, but I feel like we got it straight now. BMI is not a diagnosis. The obesity, morbid obesity,etc. are diagnoses. Those can be coded per coding clinic as they are ALWAYS significant condition. What was getting me:
"Question:
If the provider documents overweight in the history and physical and/or discharge summary only, without additional documentation to support the clinical significance of this condition, can it be coded? There is no other documentation to support clinical significance. Can we also assign the BMI code?
Answer:
No, neither the code for overweight nor the BMI code is assigned if there is no documentation that the diagnosis of overweight meets the definition of a reportable secondary diagnosis. While overweight may place a patient at increased risk for certain medical conditions, it does not automatically meet the definition of a reportable diagnosis.
For inpatient reporting purposes, the definition for other diagnoses is interpreted as additional conditions that affect patient care in terms of requiring:
clinical evaluation; or
therapeutic treatment; or
diagnostic procedures; or
extended length of hospital stay; or
increased nursing care and/or monitoring.
I was hung up on this one and wasn't putting it together that this is referring to OVERWEIGHT as a "diagnosis" not obesity/morbid obesity. I am good now! We are coding it as directed per Coding Clinic (always have been), but I am more comfortable now with it.
Thank you all your help. I'm glad I have a strong Coding Educator to keep my RN brain on track with coding!
coding clinic has specifically answered this question and determined that obesity and morbid obesity are always clinically significant. This was reiterated in CCQ42018p77.
Katy
I agree with you here. So I would like to pose the question to you: When "BMI" is the only clinical indicator you have (NO diagnosis of obesity, morbid obesity, overweight, etc.), how do you clinically validate and support your query to the provider, especially to denial proof your clarification? If your query is based on a 3-part format (Clinical Indicators, Risk Factors, and Treatment), what is your "Treatment"?
Example: 1 day LOS for elective procedure or 1-2 day LOS for UTI. The patient was completely mobile and independent, Regular diet, no RD, PT, OT consult. No assistance by staff, no mobility/ambulation issues, no sleep apnea, no respiratory issues, no major chronic conditions. Only a BMI of 40-41. Based on CC guidance that the "diagnosis" must meet reportable criteria for secondary diagnosis, what is your "MEAT" for the associated medical diagnosis, which will then allow you to capture the BMI severity/CC?
I think this is where a lot of people are getting confused or hung up...It's not over whether to report an already stated diagnosis of obesity, morbid obesity, etc., it's when there is no associated diagnosis but a BMI documented in the Vital Signs by the RN or other staff. The issue becomes the decision to query for it...
Thank you so much for your assistance and guidance on this matter.
Angelica N.
It is EASIER to ask for clinical relevance in the event RD, RN staff or MD counsel the patient, but, at least per AHA, this is not required in order to be reported.
Paul Evans, RHIA, CCDS