Q&A: Morbid obesity
Q: Coding Clinic, Third Quarter 2011, p. 4 states:
“…morbid obesity is a chronic condition and; therefore, can be coded as a secondary diagnosis without treatment.” (emphasis added)
An article in the CDI Journal, “From the Forum: Manage denials for BMI morbid obesity,” seems to indicate that providers should document how the obesity affects patient care.
What level of patient care needs to be documented?
A: The Coding Clinic you are referring to states:
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.
Coding Clinic clearly states that morbid obesity should be coded when it is documented by the provider. It speaks to the fact this condition is always clinically significant. That said, morbid obesity is almost always addressed by both the provider and the nursing staff caring for the patient. These patients are more prone for infections, musculoskeletal injury, skin breakdown, respiratory compromise, etc., and, therefore, the medical decision making and care for this patient will be more complicated. This is why we are able to code this diagnosis whenever it is documented by the provider.
After this Coding Clinic was released, I have not seen a denial for this diagnosis. If you feel you need to expand documentation related to the condition, ensure your nursing plans reflect care of a morbidly obese patient. Your provider should also include their concerns related to the condition in their assessments.
Editor’s note: Laurie Prescott, RN, MSN, CCDS, CDIP, CRC, answered this question. Prescott is the CDI Education Director at BLR Healthcare in Middleton, Massachusetts. This article orginally appeared on the CDI Blog.