Partnership Guide 2023Obesity

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A BMI cannot be a standalone diagnosis. When applicable, a clinical/nutritional diagnosis, such as Overweight, Obesity, or Morbid Obesity must be documented by the provider in addition to the BMI.

BMI needs to be measured annually, preferably with each patient visit

Although obesity types can be described by these BMI groups, ICD-10 does not use these classifications for obesity code assignment. The accompanying BMI measure is used to support the diagnosis.

If the BMI is abnormal, any associated conditions should be documented as well: for example, hypertension and diabetes are etiologically linked to obesity

BMI does not diagnose body fatness or health, but is a measure to be used as a screening tool.

Morbid obesity was renamed to include due to excess calories

Physicians or qualified health care providers should evaluate and assess patients to determine an individual’s health status and risks. BMI documentation (and BMI code assignment) may be made by a clinician other than the patient’s provider

Body mass index (BMI)

Body fat is measured through BMI

BMI screening is a Medicare quality measure

Use the following equation to calculate BMI:

BMI is a person’s weight in kilograms (kg) divided by his or her height in meters squared

Unhealthy BMI classifications:

Overweight BMI ≥25.0 to 29.9 kg/m²
Obesity BMI ≥30 kg/m²
- Class I, BMI of 30.0 to 34.9 kg/m²
- Class II, BMI of 35.0 to 39.9 kg/m²
- Class III, BMI ≥40 kg/m²

img2CDC BMI calculatorimg3Example 1*71 y/o WF presents for refills of Carvedilol and furosemide. PMH significant for R breast cancer, mastectomy, obesity, and CHF. Lost 4lbs since last visit.Temp 99.2, BP 140/94, Pulse 88, Ht 5’1”, Wt 265 BMI 50.1Assessment/PlanPulmonary edema with heart failure – refill Carvedilol CR 40mg qd, #30, 2 refills; furosemide 40 mg bid, #60, 2 refillsMorbid obesity – continue low-fat diet provided during AWVCoded asI50.1 - Left ventricular failure, unspecified (heart failure w/edema)E66.01 - Morbid obesity due to excess caloriesZ68.43 - Body Mass Index 50.0-59.9Example 2*58 y/o WF presents for refills of Carvedilol and furosemide. PMH significant for obesity, and CHF.Temp 99.2, BP 140/94, Pulse 88, Ht 5’1”, Wt 210, BMI 39.7Assessment/PlanCHF – refill Carvedilol CR 20mg qd, #30, 2 refills; furosemide 20 mg bid, #60, 2 refillsObesity – scheduled with nutritionist and exercise program at Wellness CenterCoded asI50.9 – CHF NOSE66.9 – Obesity NOSZ68.39 BMI 39.0 to 39.9Providers must confirm the accuracy of their diagnoses to ensure that diagnosis and coding practices comply with ICD-10-CM Official Guidelines for Coding and Reporting and all applicable legal requirements. Failure to address diagnosis inaccuracies can result in administrative sanctions and potential financial penalties. Accurate coding and submission activities allow us to provide the best benefits and resources possible to our customers.This guide is informational and not meant to replace the clinician’s judgment when caring for the patient.Content updated April 2023.Example 3*71 y/o WF presents for refills of Carvedilol and furosemide. PMH significant for R breast cancer, mastectomy, obesity, and CHF. Pt has gained 4 lbs since last visit.Temp 99.2, BP 140/94, Pulse 88, Ht 5’1”, Wt 210, BMI 39.7Assessment/PlanPulmonary edema with heart failure – refill Carvedilol CR 40mg qd, #30, 2 refills; furosemide 40 mg bid, #60, 2 refillsMorbid Obesity – continue low-fat diet provided during AWVCoded asI50.1 - Left ventricular failure, unspecified (heart failure w/edema)E66.01 - Morbid obesity due to excess caloriesZ68.39 BMI 39.0 to 39.9It is important to note that the diagnosis selection is based on clinical judgment. Every patient is different.*The sole purpose of the examples is to demonstrate the application of coding guidelines discussed in the materials. Examples do not represent complete documentation of a condition, nor provide any clinical advice. Each patient and medical record is unique, and assignment of codes depends solely on the distinct documentation within an individual record.img42023 Medicare Advantage Partnership GuideWelcomeContentsDocumentation Best Practices2023 Medicare Advantage ICD-10-CM Quick Reference Code GuideDisease-Specific Webinar LinksConditioning Reporting GuideReporting Common ConditionsAtrial FibrillationCancerChronic Kidney Disease (CKD)Chronic Obstructive Pulmonary Disease (COPD)Congestive Heart Failure (CHF)DVT and PEDementiaDiabetes Mellitus (DM)Major DepressionObesityPeripheral Artery Disease (PAD)Substance Use/Abuse/DependenceTobacco and E-Cigarette Use/AbuseSocial Determinants of Health