Treating obesity: Key coding considerations

February 19, 2015

Insurance carriers have come a long way when it comes to reimbursing for obesity-related treatment. However, you will need to make sure that your diagnosis coding is specific and complete in order to support medical necessity.

Insurance carriers have come a long way when it comes to reimbursing for obesity-related treatment.  However, you will need to make sure that your diagnosis coding is specific and complete in order to support medical necessity.

The first code set to review when coding for obesity is: (See Diagnosis Codes Table). You need to use V77.8 for obesity screening services.

When you look up any of the obesity codes in your ICD-9 code book, you will see the instruction to use an additional code to identify Body Mass Index (BMI), if known.

The ICD-9 codes applicable for obesity complicating pregnancy are 649.10 – 649.14. When utilizing these codes, you should also code to identify the obesity level and the BMI, if known.

According to the NCD for Treatment of Obesity, which can be found at Treatment of Obesity NCD,  services performed in connection with the treatment of obesity are covered by Medicare when such services are an integral and necessary part of a course of treatment for diseases such as hypothyroidism, Cushing’s disease, hypothalamic lesions, cardiovascular diseases, respiratory diseases, diabetes, and hypertension.

So you can see that your documentation and claim need to include all diagnoses that the patient presents with that would describe the complexity of his/her conditions. Medicare covers Intensive Behavioral Therapy for obesity and Bariatric Surgery when the guidelines have been met for each.

For Intensive behavioral therapy, obesity is defined as a body mass index (BMI) ≥ 30 kg/m2, for the prevention or early detection of illness or disability. The full NCD can be found at NCD for Intensive Behavioral Therapy for Obesity.

Related: ICD-10 training: Coding for diabetes

For bariatric surgery or other treatment of obesity, Medicare recognizes that obesity may be caused by medical conditions such as hypothyroidism, Cushing’s disease, and hypothalamic lesions, or can aggravate a number of cardiac and respiratory diseases as well as diabetes and hypertension. Non-surgical services in connection with the treatment of obesity are covered when such services are an integral and necessary part of a course of treatment for one of these medical conditions.

In order to be considered for bariatric surgery, Medicare beneficiaries need to have a body-mass index ≥ 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity. The full NDC can be found at CMS NCD for Bariatric Surgery for Treatment of Morbid Obesity.

Next page: Get to know the obesity diagnosis codes