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 it ‘impacts’ care, a condition is reportable.  If you were caring for a male that required hernia repair, how would it impact your care plan if your patient had a BMI of 25 versus a BMI of 41? Hence, it is ‘always’ reportable! 
  • 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

  • edited November 2018

    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? 


    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.
  • The BMI was documented as 40.65, but there was no documentation of obesity, morbid obesity, etc. No mention of skin or ambulation issues. There were no nursing, dietitian, or PT/OT notes in the chart and no orders for bariatric equipment or a special diet. It was a 2-day stay for gastroenteritis.  Comorbidities include hypertension.  Would you query for obesity / morbid obesity in this case?
  • This is a difficult question- it looks as though the only indicator you have is the BMI and we need to remember a patient may present with a high BMI and not be morbidly obese. If they are highly muscular their BMI will be higher for example. Do you have evidence to support the presence of any comorbidities?
  • 50 year old with hypertension and is a smoker with COPD - otherwise healthy.
  • 50 year old with hypertension and is a smoker with COPD - otherwise healthy.

    So, NOT a world champion body builder. :)  (I had the same thought as Laurie and was going to ask if he was a professional 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

  • sounds like this would make a good topic for provider education
  • Question: BMI is 45 and the progress note states "morbidly obese" under the objective findings area. "General: AAOx3, NAD, Morbidly obese". Do you consider this a diagnosis or just a description requiring a query?
  • Erica, are your referring your BMI concern in context of pregnancy?
    Marjie
    mlbuntze@texaschildrens.org
  • edited January 4
    mlbuntze said:
    Erica, are your referring your BMI concern in context of pregnancy?
    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!

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