To code BMI do you need an associated diagnosis?

cmorell

I thought I was taught that it was not enough to have a BMI < 19 or >40, that you needed an associated diagnosis such as morbid obesity or cachexia etc.

But when a fellow CDI threw it in the encoder, it will give the CC without an associated diagnosis.

Has this changed?

I was also under the impression that it affected SOI/ROM but don't have access to the APR DRG Grouper.

Thanks

Unknown

Morbid obesity - SOI 2 ROM 1
BMI 45 -49.9 SOI 2 ROM 1
Hope that helps.

Tracey Carey RN
Clinical Documentation Specialist
Office 686-7421
TTCarey@UAMS.edu

cmorell

So, people have been helpful sending me coding clinics. But what I literally read is that:
you can code the BMI.
The associated diagnosis must be documented by the provider
BUT I THINK THAT MEANS:
to code the associated diagnosis it must be documented by the provider,
NOT
that to code the BMI you also have to have the associated diagnosis.

stacy.vaughn

So, you do need an associated diagnosis to accompany the BMI. Otherwise,
you would collecting a diagnosis from nursing/dietary documentation versus
from the physician.

Coding CLinic 2Q 2010.

There has been some confusion as to whether nursing staff documentation is
acceptable for assigning the body mass index (BMI). Since hospitals are
allowed to code the BMI based on the dietitian?s documentation, it would
seem reasonable to assign the BMI based on the nurse?s documentation as
well. Can coders use nursing documentation to assign the BMI?

Answer:

Yes, the BMI may be assigned based on medical record documentation from
clinicians, including nurses and dietitians who are not the patient?s
provider. As stated in the Official Guidelines for Coding and Reporting,
BMI code assignment may be based on medical record documentation from
clinicians who are not the patient?s provider, since this information is
typically documented by other clinicians involved in the care of the
patient. Dietitians were only mentioned as an example of a clinician that
might document BMI information.

However, the associated diagnosis (such as overweight, obesity, or
underweight) must be documented by the provider.

Refer to the Official Guidelines for Coding and Reporting for additional
discussion.


Stacy Vaughn, RHIT, CCS, CCDS
Data Support Specialist/DRG Assurance
Aurora Baycare Medical Center
2845 Greenbrier Rd
Green Bay, WI 54311
Phone: (920) 288-8655
Fax: (920) 288-3052

cmorell

Thank you, so if the provider only documented obesity instead of morbid obesity would that be a different SOI/ROM? Probably not since the BMI would still be over 40.
So, one does not need to get more specificity of obesity, it does not show greater SOI/ROM.

stacy.vaughn

correct

Stacy Vaughn, RHIT, CCS, CCDS
Data Support Specialist/DRG Assurance
Aurora Baycare Medical Center
2845 Greenbrier Rd
Green Bay, WI 54311
Phone: (920) 288-8655
Fax: (920) 288-3052

catladyrn

Charrington wrote: "But when a fellow CDI threw it in the encoder, it will give the CC without an associated diagnosis."

and then wrote:

"BUT I THINK THAT MEANS: to code the associated diagnosis it must be documented by the provider, NOT that to code the BMI you also have to have the associated diagnosis."

I have to disagree here, and I point you to CC4Q2008: "The provider must provide documentation of a clinical condition, such as obesity, to justify reporting a code for the body mass index. To meet the criteria for a reportable secondary diagnosis, the BMI would need to have some bearing or relevance in turns of patient care."

The BMI can't stand there by itself. I think the reason the encoder allowed the CC is that there is no specific list of diagnoses that the computer automatically links to BMI. The associated diagnosis can be anything that's clinically relevant. Encoders are great, but they are only as good as what you enter.

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

dsmith12h@aol.com

I most recently had a chart where the physician documented the diagnosis Obesity and the BMI in the chart. The coders did not code the BMI. I asked the coding auditor ( that's who we have to direct our questions) and she said the BMI did not meet the definition of other diagnoses and therefore was not coded. My reply was-- Obesity is the diagnosis and it was coded even though it was not evaluated, treated, monitored etc. The BMI is a simply a measure to quantify the level of obesity, the BMI is not a diagnosis. If the Obesity is coded as a secondary diagnosis why would the BMI not be coded to support the diagnosis? Any thoughts?

stiltnersl

Wonder what the coding auditor meant by didn’t meet definition? We code the BMI if documented even if the BMI is

Wonder what the coding auditor meant by didn’t meet definition? We code the BMI if documented even if the BMI is <40 and the diagnosis of obesity or morbid obesity is documented.

Sherry Stiltner , RHIT
_______________

Mountain States Health Alliance

Patient Resource Management | Manager, Clinical Documentation Specialist

Telephone: (423) 431.6637
| Facsimile: (423) 431.2917 |
stiltnersl@msha.com

paxneros

Our Encoder will ask for BMI if you enter morbid Obesity or obesity as a diagnosis. However, it will not ask for the diagnosis if you enter just the BMI.

We've always coded both a condition and the VCode if we have it.

Unknown

I will query for further specificity if I see a diagnosis of obesity and a BMI over 40.


Charlene

dsmith12h@aol.com

This is the reference she sited: Relative to this case-- The Obesity (diagnosis) was coded. The BMI did not get coded.
Section III. Reporting Additional Diagnoses
GENERAL RULES FOR OTHER (ADDITIONAL) DIAGNOSES
For 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.
The UHDDS item #11-b defines Other Diagnoses as “all conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment received and/or the length of stay. Diagnoses that relate to an earlier episode which have no bearing on the current hospital stay are to be excluded.” UHDDS definitions apply to inpatients in acute care, short-term, long term care and psychiatric hospital setting. The UHDDS definitions are used by acute care short-term hospitals to report inpatient data elements in a standardized manner. These data elements and their definitions can be found in the July 31, 1985, Federal Register (Vol. 50, No, 147), pp. 31038-40.

catladyrn

How does the coding auditor expect the obesity to meet the definition of secondary diagnosis? Isn't there enough literature out there showing the impact of obesity on illness? Does the patient have to be put on a diet or have to wear CPAP while they are in the hospital? I think we all understand the definition of secondary diagnosis, but there are some diagnoses, IMO, that have an inherent impact on a hospital stay. There are several chronic conditions that are normally coded, such as Crohn's or s/p renal transplant, because they are so tied into the patient's level of wellness that they can't be separated, even if they're not actively being treated during the stay. Measuring and calculating the BMI, and using it to make a determination if additional resources such as a diet consult are needed, could be said to meet the definition of clinical evaluation, as well.

The coders here go back and forth on this, depending on what day of the week it is...

Renee


Linda Renee Brown, RN, CCRN, CCDS
Certified Clinical Documentation Specialist
Banner Good Samaritan Medical Center

ssalinas

Not sure if I am right page in this discussion of obesity and BMI. Obesity generally meets the reporting guideline even if based only on evaluation by dietary, special diets etc. Once obesity is determined to meet the definition of other dx, the BMI can be coded based on General Coding Guidelines and the instruction found in the tabular under obesity.

Conventions for ICD-9-CM
Coding Clinic, Fourth Quarter 2008 Page: 202 to 206 Effective with discharges: October 1, 2008

"Code first" and "Use additional code"notes are also used as sequencing rules in the classification for certain codes that are not part of an etiology/ manifestation combination. See Section I.B.9. "Multiple coding for a single condition."

General coding guidelines
Coding Clinic, Fourth Quarter 2008 Page: 206 to 211 Effective with discharges: October 1, 2008

B. General Coding Guidelines

9. Multiple coding for a single condition

In addition to the etiology/manifestation convention that requires two codes to fully describe a single condition that affects multiple body systems, there are other single conditions that also require more than one code. "Use additional code" notes are found in the tabular at codes that are not part of an etiology/manifestation pair where a secondary code is useful to fully describe a condition. The sequencing rule is the same as the etiology/manifestation pair, "use additional code" indicates that a secondary code should be added.

dsmith12h@aol.com

Thank you for the reference. I hope this will help me.

dsmith12h@aol.com

Thanks Renee, The patient did have a dietary consult, however, the obesity was not the focus of the consult. There really wasn't anything to support the definition of other diagnoses relative to the Obesity (other than the BMI). The obesity by itself was nonetheless coded. I thought the obesityI may have been captured because it was a chronic condition (much the same as CHF -- a chronic condition). I believe the BMI may not have been coded simply because it would have been the determining factor for moving the DRG relative to it being a "cc" and fear of a patential denial because it was the only "cc". I will readdress this because I really feel if queries are necessary to obtain accurate and complete documentation, I need to know what supporting documentation is required to capture the BMI in stiuations where "obesity has been coded. There are several levels of obesity and I feel the BMI is added to help quantify the levels of obesity for statistical purposes--not coding it when it is documented is basically unspecified as a mere generalization.

Our coders seem to go back and forth on this as well. I think I just need to understand what they need to support the diagnosis and htis has been aske din the past but basically shrugged off. There was an instance where a special bed was ordered for an obese patient to accomodate them better and the obesity was not documented due to lack of supporting documentation. I was told that it didn't support the diagnosis because everybody needs a bed.

I'm lost and confused. Does CMS have any direction as to what is need to support the coding of Obesity? What are other hospitals finding in the documentation (other than an op-note, bed or dietary consult) to qualify as evaluation, treatment, monitoring etc.

Sorry so long!


Debbie

ctrygar

As a coder, they should not code bmi >40 unless a doctor specifies morbid obesity and there is treatment designated for that. We recently had a denial for the chart where doctor documented obesity but dietary documented bmi> 40. BMi of >40vwas coded and that was a cc however We were denied the cc because the patient did not receive any teaching from dietary for weight reduction nor was there any documentation were care was increased due to bmi>40 nor was there documentation of morbid obesity by the physician.