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Can the E66 morbid obesity codes be assigned if the BMI is less than 40 when there is physician documentation of morbid obesity diagnosis?


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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