Morbid Obesity Denials
I reviewed a chart with the dx of Morbid obesity noted only in the ER MD's ROS under the GI section. Patient's BMI was > or equal to 40. The attending MD did not note obesity in his documentation. Coder requested a query to clarify the obesity, as this would be a CC. CDI placed a query for the obesity to the attending, however after no response from MD, I informed my CDI supervisor of the next step with this MD. However, upon CDI supervisor review of this chart and the pending query for MD, my supervisor informed me as noted:
"This was just noting she had an obese stomach. I do not feel this is a reportable diagnosis. There was no complication, monitoring or treatment for the obesity. I’ve gotten quite a few denials for this. She was able to plan her own meals and no nutritionists were on the case. I would delete the query and notify the coder."
It was my understanding that morbid obesity would be clinically significant since this condition may require "increase nursing care" and increased risk for complication.
Any thoughts on this one...
"This was just noting she had an obese stomach. I do not feel this is a reportable diagnosis. There was no complication, monitoring or treatment for the obesity. I’ve gotten quite a few denials for this. She was able to plan her own meals and no nutritionists were on the case. I would delete the query and notify the coder."
It was my understanding that morbid obesity would be clinically significant since this condition may require "increase nursing care" and increased risk for complication.
Any thoughts on this one...
Comments
Volume 5 Fourth Quarter
Number 4 2018, Page 77
Body Mass Index
The AHA Central Office has received many questions about assigning body mass index (BMI) codes. The following questions and answers are being published in response to many requests for assistance and to clear up any confusion.
Question:
Is there a list of diagnosis codes that are associated with the body mass index (BMI) measurement codes? Can BMI codes be assigned without a corresponding documented diagnosis of overweight, obesity or morbid obesity from the provider?
Answer:
No, the provider must provide documentation of a clinical condition, such as overweight, obesity or morbid obesity, to justify reporting a code for the body mass index. As stated in the Official Guidelines for Coding and Reporting, Section I.B.14, the associated diagnosis (such as overweight or obesity) must be documented by the patient’s provider. If the linkage between the BMI and a clinical condition is not clearly documented, query the provider for clarification. ICD-10-CM does not provide definitions or a list of diagnosis codes associated with BMI.
Question:
If the provider documents obesity or morbid obesity in the history and physical and/or discharge summary only, without any additional documentation to support the clinical significance of this condition, can it be coded? There is no other documentation to support clinical significance for this condition such as evaluation, treatment, increased monitoring, or increased nursing care, etc.
Answer:
Obesity and morbid obesity are always clinically significant and reportable when documented by the provider. In addition, if documented, the body mass index (BMI) code may be coded in addition to the obesity or morbid obesity code.
Question:
The patient presented to the Emergency Department (ED) in full cardiac arrest and respiratory failure due to an acute myocardial infarction. He was resuscitated, transtracheally intubated and placed on mechanical ventilation. The patient was admitted to the intensive care unit and after a short period he expired. The ED physician documented acute respiratory failure. However, the attending physician did not document acute respiratory failure in the health record. Is acute respiratory failure a codeable secondary diagnosis based on the ED physician's documentation of this condition?
Answer:
Yes, code 518.81, Acute respiratory failure, should be assigned based on the ED physician's diagnosis, as long as there is no other conflicting information in the health record. Whenever there is any question as to whether acute respiratory failure is a valid diagnosis, query the provider.
© Copyright 1984-2018, American Hospital Association ("AHA"), Chicago, Illinois. Reproduced with permission. No portion of this publication may be copied without the express, written consent of AHA.So I think, based on your ED physician's documentation, you can code Obesity.
I am looking for help clarifying the distinction between a diagnosis versus description/exam findings. I understand that "obese abdomen" and "obese body habitus" would not be used to code dx. However, if you have a person with BMI of 44, 161.2 Kg/354 pounds and the Provider states under exam findings "morbidly obese". The coding team does not code the dx in this situation because it is located under exam findings. Is this standard practice for you facilities? I feel like it would be hard to send a query in this case because your clinical indicators would include:
--"morbidly obese" documented on progress note exam findings
--BMI 44, 161.2kg
Please clarify:
--Morbid obesity
--Other, specify
The providers will not be happy in this scenario. Any suggestions?
In my view, if the exam documents 'morbidly obese' this is adequate (and clear) documentation of the condition. I, as a trained professional coder practicing CDI, do not understand the stance of your coding team?
If I were an MD, the query would irritate me, too. You could, if you wish, write AHA directly for advice.
Paul Evans, RHIA, CCS, CCS-P, CCDS
Hi, Angela
Agree that the descriptions cited above do not support coding of 'morbid obesity'. But, "Exam: Morbidly Obese" is adequate in my view. Particularly, when other clinicians, RNs, RD, also note a patient with BMI supportive of the condition as well as also describing a morbidly obese patient.
Others may disagree?
Paul