Updated on: September 23, 2014

Coding Current Events: Obesity

By Kathy Pride, CPC, RHIT, CCS-P
Original story posted on: September 22, 2014

What kind of fruit are you? Are you an apple, pear, or maybe a banana? Eating an apple may be good for you, but looking like an apple is not. Researchers reported in last Wednesday’s Journal of the American Medical Association that 54 percent of U.S. adults have abdominal obesity, up from 46 percent in 1999-2000. Abdominal obesity is defined as a waistline of more than 35 inches in women and more than 40 inches in men.

Belly fat not only makes people look apple-shaped, but often means fat has built up deep inside the body, around the liver and other abdominal organs. According to a recent report, obesity is holding steady, but our waistlines are getting dangerously bigger. Those whose fat has settled mostly around their waistlines instead of in their hips, thighs, buttocks, or all over, are known to run a higher risk of heart disease, diabetes, and other obesity-related ailments. 

Measuring waist circumference helps screen for possible health risks that come with overweight and obesity. If most of your fat is around your waist rather than at your hips, you’re at a higher risk for heart disease and type 2 diabetes. This risk goes up with a waist size that is greater than 35 inches for women or greater than 40 inches for men. Increased waist circumference also can be a marker for increased risk, even in persons of normal weight.

In the coding world we measure obesity by the “body mass index,” or BMI. In adults, BMI is calculated by using weight and height. BMI is used because, for most people, it correlates with their amount of body fat. In fact, reporting a patient’s BMI is an ICD-9 and ICD-10 coding guideline for patients with a diagnosis of overweight or obesity.

  • An adult who has a BMI between 25 and 29.9 is considered overweight.
  • An adult who has a BMI of 30 or higher is considered obese.

When coding for obesity in ICD-9, there were 4 choices:

  • 278.00 – Obesity, unspecified
  • 278.01 – Morbid obesity
  • 278.02 – Overweight
  • 278.03 – Obesity hypoventilation syndrome

ICD-10 adds some specificity, giving us a few additional options:

  • E66.01 – Morbid (severe) obesity due to excess calories
  • E66.09 – Other obesity due to excess calories
  • E66.1 – Drug-induced obesity
  • E66.2 – Morbid (severe) obesity with alveolar hypoventilation
  • E66.3 – Overweight
  • E66.8 – Other obesity
  • E66.9 – Obesity, unspecified

Both ICD-9 and ICD-10 guidelines instruct us to use an additional code to identify body mass index (BMI). In ICD-9 we look to category V85 and in ICD-10 we look to category Z68. Both classifications classify the BMI by age. One difference, however, is ICD-9 considers persons over the age of 20 as adults and ICD-10 classifies adults as persons over the age of 21. In children the BMI is classified by the age and sex percentile.

However you measure obesity, by your waist or by your BMI, it is important to understand the effect this condition is having on our healthcare system. According to the Journal of American Medicine, 34.9 percent of adults and 17 percent of children in the U.S. are obese. Obesity costs $150 billion a year—10 percent of the national medical budget. It is safe to say, obesity has reached epidemic proportions. Research has shown that as weight increases, the risks of developing comorbidities increases exponentially. If you are overweight or obese you are at greater risk of developing:

  • Coronary heart disease classified to category I25 in ICD-10 which includes conditions such as I25.10 – Atherosclerotic heart disease of native coronary artery without angina pectoris
  • Type 2 diabetes classified to category E11 in ICD-10 which includes type 2 diabetes with and without manifestations such as neuropathies, circulatory complications, and ophthalmic conditions
  • Cancer such as endometrial classified to C54.1, breast classified to category C50 and colon classified to category C18
  • Hypertension classified to I10.
  • Dyslipidemia classified to category E78
  • High cholesterol – E78.0
  • High levels of triglycerides – E78.1
  • Or Mixed hyperlipidemia – E78.2
  • Stroke/Cerebral Infarction classified to category I63
  • Sleep apnea classified to category G47 and respiratory problems classified to categories J43 Emphysema, J44 COPD, and J45 Asthma
  • Osteoarthritis classified to categories M16 – M19
  • Gynecological problems
  • Abnormal menses conditions classified to categories N91 and N92
  • Infertility conditions classified to N97

The major cause of obesity is simply an imbalance of calorie intake and activity. And though the solution sounds simple—eat less and exercise more—the root of the problem and solutions are much more complex. Weight gain in this country is primarily due to changes in our culture and lifestyles. Where we eat, what we eat, and how much we eat has changed considerably over the last 50 years with the introduction of “fast food” and processed foods. To compound the issue, we are less active as a society. We sit in front of our computers for work, entertain ourselves watching TV or playing video games, and are generally less active. This phenomenon is not likely to reverse itself anytime soon. The first step in getting healthier is getting our healthcare system on board. 

Similar to our mental illness crisis, healthcare needs to treat obesity like a disease and not a stigma or a lifestyle choice. In 2012, Medicare began paying for obesity counseling, and it appears commercial insurance carriers are starting to get on board as well. I recently saw that a major healthcare insurance company is now allowing unlimited visits to a Registered Dietician. 

So, fellow coders, let’s start a get healthy campaign! Two simple steps you can take that are FREE are focus on a healthier eating plan and be more active.

So put down that Twinkie, take the stairs, drink more water, and have a salad for lunch!

About the Author

Kathy Pride, CPC, RHIT, CCS-P, is vice president of professional services for Panacea Healthcare Solutions. Kathy has extensive experience in management, project implementation, coding, billing, physician documentation improvement, compliance audits and education. She is also an approved ICD-10 Trainer through the American Health Information Management Association (AHIMA) and a previous member of the AAPC National Advisory Board (1998 – 2000).

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Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.