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Q:
Can the E66 morbid obesity codes be assigned if the BMI is less than 40 when there is physician documentation of morbid obesity diagnosis?
A:
You can assign the E66 morbid obesity code if it is specifically documented by the provider, even if the BMI is <40. Per ICD-10 Convention I.A.19. Code Assignment and Clinical Criteria, “The assignment of a diagnosis code is based on provider’s diagnostic statement that the condition exists. The provider’s statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis”.
If there is documentation of overweight or obesity by provider & BMI is >40, then you can code the Z code for BMI >40 and get the NTA point for morbid obesity without having specific MD documentation of “morbid” obesity, as BMI is one of the few ICD-10 codes that can be assigned based on documentation from clinicians other than the provider. (Check out this webinar – Moving Mountains Series: PDPM – Developing ICD-10 Expertise for Effective Coding of Clinical Categories & Non-Therapy Ancillary)
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Blog by Shelly Maffia, MSN, MBA, RN, LNHA, QCP, CHC, Director of Regulatory Services, Proactive Medical Review
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