Has anyone else had a BMI denial, if so how are you winning?

i have used the below with no luck.

Coding Clinic 4th Q, 2018 pg 77 - "obesity and morbid obesity are always clinically significant and reportable when documented by the provider. In addition, if documented the BMI code may be coded in addition to the obesity or morbid obesity code."


Coding Clinic 3rd Q, 2011 pg. 4 - "individuals who are overweight, obese or morbidly obese are at an increased risk for certain medical conditions when compared to person of normal weight.  Therefore, these conditions are always clinically significant and reportable when documented by the provider..."


  • Greetings, yes, those denials are starting to come in. What we have told providers is that if they feel the diagnosis is significant, then they need to provide education or counseling to their patients and document that. For example: lifestyle modification, dietary counseling, nutrition consult, etc.

    We have found that if providers add more detail when they first make the diagnosis as to how it plays a role in the current admission, it does help to capture that.

    Hope this helps

  • I have had many and no luck overturning these denials.  I utilize this coding clinic as well.  No go.  They come back and cite coding guidelines and secondary diagnosis criteria. 

  • For the record, we still code and query for obesity/BMI.  I think they're wrong.  :)

  • I 100% agree that they are wrong!!!    I will reach out to my manager re: educating providers on adding more detail- that's a great idea!

    Thanks ladies!

Sign In or Register to comment.