Q&A: Coding obesity

Q: Does your facility have any requirements for providers to document how a diagnosis of obesity and/or morbid obesity has met the Uniform Hospital Discharge Data Set (UHDDS) definition of “monitoring, evaluating, assessing, etc.” in order for it to be coded?  For example, if a provider only lists the diagnosis in the progress notes or discharge summary and doesn’t elaborate on how it has impacted the patient stay or how it was monitored, would the coders pick it up?

A: Some facilities follow the Coding Clinic advice on obesity/morbid obesity, which states that only body mass index (BMI) is required. The UHDDS definition is met as they are “assessing and stating the condition and measuring with BMI.”

Most CDI and coding professionals code obesity with the understanding that obesity is always clinically significant for the patient’s care. On the backend, facilities often receive more denials for reporting only BMI than they do for obesity. The payers will argue that the BMI must meet the UHDDS definition of an other or secondary diagnosis. In appeals, one could argue that the BMI is assigned to measure and quantify the severity of the obesity and supports the additional time and assistance required to care for the patient. 

Referencing this article in your BMI denial appeals may be helpful. It includes obesity’s impact on the delivery of nursing care as well as body systems. Also, an appeal specialist may reference Coding Clinic when appealing a denial for obesity/BMI. 

Editor’s note: This question was answered by members of the ACDIS CDI Leadership Council. If you’d like to apply for the 2022/2023 Leadership Council term, click here.