Metabolic Syndrome as PDX for Bariatric Surgery
I was wondering if anyone has encountered any issues with metabolic syndrome being the PDX in bariatric procedure cases? Instructional note on E88810 states use additional codes for associated manifestations-which at the bare minimum would be obesity and BMI.
I didn't know if payors dictated in LCD/NCD that obesity be the PDX?
Thanks in advance
Comments
Bariatric Surgery for Morbid Obesity due to Metabolic Syndrome
Coding Clinic for ICD-10-CM/PCS, Third Quarter 2022: Page 6
Coding advice or code assignments contained in this issue effective with discharges September 20, 2022
Question:
The patient presented for elective laparoscopic sleeve gastrectomy. The provider documented in the discharge summary, "Clinically severe obesity (BMI 35.67) and metabolic syndrome," as the reason for admission. The instructional note at code E88.81, Metabolic syndrome, states "Use additional codes for associated manifestations, such as: obesity (E66.1-)." Would the note apply when the reason for admission is bariatric surgery due to severe obesity? In this case, what condition is sequenced as principal diagnosis, metabolic syndrome versus morbid obesity?
Answer:
Assign code E88.81, Metabolic syndrome, as the principal diagnosis. Assign codes E66.01, Morbid (severe) obesity due to excess calories, and Z68.35 Body mass index [BMI] 35.0-35.9, adult, as additional diagnoses. The instructional note "Use additional code for associated manifestations" at code E88.81 indicates the proper sequencing of metabolic syndrome with obesity (etiology followed by the manifestation). Although there is not a "code first note" at category E66-, Overweight and obesity, the coding instruction at code E88.81 must be followed.