Morbid obesity question

Snook@fmchealth.orgSnook@fmchealth.org
in CDI Talk Archive
I have a question. I know when we are querying and coding for morbid obesity it is the BMI of 40 or greater that is the CC. Does the physician have to document the term morbid obesity in the Medical record to code this diagnosis or is a finding of obese abdomen on physical exam or just the term obesity good enough? Do we have to have the term morbid in the medical record?

Mary L. Snook RN-BC
Clinical Documentation Improvement Specialist
Fairfield Medical Center
740-689-4443



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Comments

  • Unknown
    edited March 2016
    Morbid obesity must be said /doc by MD thanks
    Jamie G Dugan RN, CCDS
    Baptist Health System
    3563 Philips Highway
    Building A, Suite 108
    Jacksonville, Florida 32207
    Phone- 904-202-4345



  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    To code morbid obesity you need the provider to say it. However, if they say 'obesity' and you code this, they will still be prompted to code the BMI. If the BMI is >40 you would still get the CC since it is attached to the BMI code not 'morbid obesity'. The 'morbid obesity' does have a higher SOI (2 vs 1).

    Thanks!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • Unknown
    edited March 2016
    Thanks for the reminder Katy!

    Jamie G Dugan RN, CCDS
    Baptist Health System
    3563 Philips Highway
    Building A, Suite 108
    Jacksonville, Florida 32207
    Phone- 904-202-4345



  • annnd2009@gmail.comannnd2009@gmail.com
    edited March 2016
    I am not sure that is correct. Morbid obesity is not an cc the bmi is... I was told there needs to be an associated diagnosis ?? Do you have reference?

    Side note - Icd 10 kind of makes the morbid obesity hypo alveolar mute... The morbid obesity already gave the cc with bmi over 40- doubt the addition effect soi/rom but not certain... ???

  • ggoodman@virginiahospitalcenter.comggoodman@virginiahospitalcenter.com
    edited March 2016
    The BMI is the CC – unless there was a change with ICD-10 I’m not aware of.
    But in order to code the BMI you need a related diagnosis (obesity or morbid obesity).
    Do you have a DRG book?
    I don’t have mine with me right now, but in the back there should be a list of all the cc/mccs you could look it up there…..


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Agree with this. I missed this in the question.

    Good catch Karen :)

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • ssalinasssalinas
    edited March 2016
    The terms "overweight" and "underweight" also allow you to code the BMI.

    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Example of impact


    Morbid Obesity is not the CC – the accompanying BMI is the “CC” under MS-DRG system.

    Designation of SOI/ ROM is as per below as I used the APR-DRG to code a hypothetical case.

    [cid:image001.png@01D11C5B.6BF78400]


    I-10 Guidelines (Excerpt)


    For the Body Mass Index (BMI), depth of non-pressure chronic ulcers and pressure ulcer stage codes, code assignment may be based on medical record documentation from clinicians who are not the patient’s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient’s diagnosis), since this information is typically documented by other clinicians involved in the care of the patient (e.g., a dietitian often documents the BMI and nurses often documents the pressure ulcer stages). However, the associated diagnosis (such as overweight, obesity, or pressure ulcer) must be documented by the patient’s provider. If there is conflicting medical record documentation, either from the same clinician or different clinicians, the patient’s attending provider should be queried for clarification.




    [cid:image004.png@01D11C5C.2F37F3A0]


    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

  • kbenson@uwhealth.orgkbenson@uwhealth.org
    edited March 2016
    As does cachexia and anorexia

    Kathleen Benson RN, BSN, CCDS
    Supervisor, Clinical Documentation Integrity
    UWHealth University of Wisconsin Hospital
    Office Location: University Crossing, 749 University Row, Suite 200
    Mailing Location: 600 Highland Avenue, Mail Code 9920
    Madison, WI 53792-9475
    608-516-5638
    kbenson@uwhealth.org



  • kbenson@uwhealth.orgkbenson@uwhealth.org
    edited March 2016
    I agree Karen. We specifically asked our coding department about the obese abdomen and they will not code obesity from just that documentation. They said, and I concur that a person can have an obese abdomen and not be technically obese.

    Kathleen Benson RN, BSN, CCDS
    Supervisor, Clinical Documentation Integrity
    UWHealth University of Wisconsin Hospital
    Office Location: University Crossing, 749 University Row, Suite 200
    Mailing Location: 600 Highland Avenue, Mail Code 9920
    Madison, WI 53792-9475
    608-516-5638
    kbenson@uwhealth.org





    HCPro, Inc., 75 Sylvan Street, Danvers MA 01923
  • angie.guiler@bergerhealth.comangie.guiler@bergerhealth.com
    edited March 2016
    For what it is worth:

    To tag on to what Paul has stated below regarding the coding guideline and meeting the definition for "other diagnosis" ensure that there is supportive documentation in the medical record that the morbid obesity affected patient care.

    If a patient has a BMI of 45 and MD documents morbid obesity but patient ambulates self to bathroom, LOS not affected, no clinical treatment of obesity, etc. it is difficult to justify/support the condition in a DRG audit.

    Lesson learned from recent denial.


    Angie Guiler RN
    Clinical Documentation Specialist
    angie.guiler@bergerhealth.com

    Berger Health System
    600 N. Pickaway Street, Circleville, OH 43113
    (740) 420-8177 Direct
    (740) 474-2126 Phone
    (740) 420-8644 Fax
    www.bergerhealth.com

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Except that there is a coding clinic that states that morbid obesity is ALWAYS clinically significant.

    Clinical significance of obesity

    Coding Clinic, Third Quarter 2011 Pages: 3-4 Effective with discharges: September 23, 2011
    Related Information
    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 clinical significance of this condition, can it be coded? There is no other documentation to support clinical significance such as evaluation, treatment, increased monitoring, or increased nursing care, etc., for this condition.
    Answer:
    Individuals who are overweight, obese or morbidly obese are at an increased risk for certain medical conditions when compared to persons of normal weight. Therefore, these conditions are always clinically significant and reportable when documented by the provider. In addition, the body mass index (BMI) code meets the requirement for clinical significance when obesity is documented. Refer to Coding Clinic, Third Quarter 2007, pages 13-14, for additional information on coding chronic conditions.


    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • arozhkovskayaarozhkovskaya
    edited March 2016
    Completely agree with Angie. We always have to justify assigning secondary Dx. We usually look for dietitian/nutrition notes to see if they were on the case and what they recommend.

    Anna Rozhkovskaya, RHIT, CCS, CCS-P
    Manager, Clinical Documentation Improvement
    Memorial Healthcare System
    Health Information Management Department
    2990 Executive Way, Miramar, Fl 33025
    (954)276-9957 Office
    (954)265-6974 Mobile
    (954)441-9459 Fax


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    I believe Morbid Obesity is 'always' reportable as it causes so many issues for clinical staff in terms of dosing, radiological exams, skin assessments, and so forth. See info here:

    [cid:image005.png@01D11C70.149EEE90]


    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Agree..it is always reportable.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Have you guys appealed with the coding clinic I posted?

    We not lost appeals that I am aware of. The coding clinic is very clear.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • kbenson@uwhealth.orgkbenson@uwhealth.org
    edited March 2016
    I agree Paul. Don't forget the high expense of bariatric beds.

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Bear in mind we also use coding to report conditions requiring or complicating care of RN - even if this means in some cases 'active intervention' is not taken to 'manage' the Morbid Obesity or something like DM Type II.

    One Example: (CREDIT AHIA Publications)

    [cid:image006.png@01D11C72.A46D96F0]



    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

  • angie.guiler@bergerhealth.comangie.guiler@bergerhealth.com
    edited March 2016
    Katy: No, I did not use the coding clinic you provided below but will in the future!

    Humana (shocker) quoted "AHA coding clinic 4th quarter 2008 page 191 specifically addresses the assignment of BMI diagnosis codes and reiterated the criteria for a condition to meet the definition of additional diagnosis as outlined in the Official Coding Guidelines"
    Humana also stated "There was no dietary consultation, further evaluation, or treatment for obesity. There was no documentation by the attending physician of the clinical significance of obesity and the BMI as it pertained to this admission". Humana continued to focus on the Coding Clinic 2008, 4th quarter.

    Thank you for the insight into the 2011, 3rd quarter coding clinic guideline will use this in the future and see what happens.
    Thank you,


    Angie Guiler RN
    Clinical Documentation Specialist
    angie.guiler@bergerhealth.com

    Berger Health System
    600 N. Pickaway Street, Circleville, OH 43113
    (740) 420-8177 Direct
    (740) 474-2126 Phone
    (740) 420-8644 Fax
    www.bergerhealth.com

    Care first. Community always.
  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Looks like they are picking and choosing their coding clinics. I am sooooooo surprised! ;-)


    Good luck!


    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Hi, Angie

    Agree w/ Katy....Humana is citing Coding Clinic to suit their individual view on this particular matter. As part of rebuttal, bear in mind that impact upon ancillary services is part of the equation.

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

    evanspx@sutterhealth.org

  • kwilliams@halifaxrmc.orgkwilliams@halifaxrmc.org
    edited March 2016
    Would the fact that special bariatric equipment needs (beds, wheelchairs, beside commodes, BP cuffs, etc.) used have any bearing?

    Kim Williams, RN
    Clinical Documentation Specialist
    Halifax Regional
    Revenue Management Department
    kwilliams@halifaxrmc.org
    (252) 535-8154
    (252) 535-8937 fax

    [cid:image001.jpg@01D11C99.1C44A5D0]




  • arozhkovskayaarozhkovskaya
    edited March 2016
    Would this be documented in the chart by nursing staff? We still have to follow coding guidelines in order to assign secondary Dx.

    Anna Rozhkovskaya, RHIT, CCS, CCS-P
    Manager, Clinical Documentation Improvement
    Memorial Healthcare System
    Health Information Management Department
    2990 Executive Way, Miramar, Fl 33025
    (954)276-9957 Office
    (954)265-6974 Mobile
    (954)441-9459 Fax


  • evanspx@sutterhealth.orgevanspx@sutterhealth.org
    edited March 2016
    Consider my current BMI is 25...If you, as an RN, were caring for me postoperatively for hernia repair, colon resection, etc, and my BMI was 42, would that impact any of the conditions below?

    Increased Nursing care or monitoring? Would you need to 'increase' your care and monitoring of a morbidly obese patient on your unit?


    [cid:image006.png@01D11C81.3C79F700]

    Paul Evans, RHIA, CCS, CCS-P, CCDS

    Manager, Regional Clinical Documentation & Coding Integrity
    Sutter West Bay
    633 Folsom St., 7th Floor, Office 7-044
    San Francisco, CA 94107
    Cell: 415.412.9421

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    But the coding clinic establishes obesity as a secondary dx in every case if documented. We do not need evidence of evaluation, treatment, monitoring, etc. The dx should be coded if it is documented by the provider.

    But yes, if you were to get a denial, I believe including ANY evidence of nursing/hospital resources in the appeal would be helpful. But the coding clinic pretty much speaks for itself. Obesity (and the BMI) should be coded regardless if documented.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited March 2016
    Completely agree with you Paul.

    If we can code hypertension because we continue a home med, I certainly think we can code morbid obesity when a patient is hospitalized. It always has clinical significance.

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    AHIMA Approved ICD-10CM/PCS Trainer
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404

  • angie.guiler@bergerhealth.comangie.guiler@bergerhealth.com
    edited March 2016
    What I am hearing is that the 2011 third quarter coding clinic can stand on its own, no further justification/documentation is needed in the medical record to support the BMI and morbid obesity code.




    Angie Guiler RN
    Clinical Documentation Specialist
    angie.guiler@bergerhealth.com

    Berger Health System
    600 N. Pickaway Street, Circleville, OH 43113
    (740) 420-8177 Direct
    (740) 474-2126 Phone
    (740) 420-8644 Fax
    www.bergerhealth.com

    Care first. Community always.

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