For this month's coding column, we get a few ICD-10 specific questions on BMI and well child visits.
Q: One of our physicians is getting conflicting information regarding the ICD-10 codes E66.01 and E66.9. We have been coding E66.9 for Body Mass Indexes (BMIs) between 30-34 and E66.01 for BMIs > 35.
She has a laminated cheat sheet card that says E66.9 is for BMIs 30-39 and E66.01 is for BMIs >40. Can you clarify when to use each of these codes?
A: The E codes E66.01 and E66.9 are used to describe various types of obesity, in words.
E66.01 is morbid (severe) obesity from excess calories. E66.9 is unspecified obesity
A range of BMI's can be assigned to various 'categories of obesity:
Ideal BMI 19-25
Severely Obese >35
Morbidly Obese >40
This table would give you E66.01 for BMIs over 40. To report specific BMI's in addition to the E codes use code Z68.xx. These are for adults. Z68.30 is 30.0 to 30.9 BMI. Z68.31 is 31.0 - 31.9 BMI etc. So the E codes loosely map to specific BMI's.
You should not likely be using E66.9. You'd only use this if you didn't know the BMI or the reason for it. If you know what the BMI is you should be able to assign it to either E66.01, E66.3 (overweight) or E66.8 other obesity.
Q: When do I use ICD-10 codes Z00.121 instead of Z00.129?
A: You use a Z00.129 (Child well w/out abnormal findings) when you aren't either dealing with or reporting any other problems along with the well-visit. The Z00.121 codes are used to report a well child visit with abnormal findings. These can be either diagnoses or signs and symptoms encountered during the visit, or other issues addressed during the encounter such as pre-existing problems or complaints. Regardless of how other issues arise - you report the additional specific diagnosis codes with the Z00.121.
If you are doing the 'well' visit and are also addressing those other issues (and have some HPI and A/P for those issues) - then that is when you bill both the wellness CPT code and the sick visit CPT code (i.e.99393, 99213-25) AND the two types of ICD-10 codes, Z00.121 and H66.41 (OM right ear for example).
Q: I’m a psychiatrist working in an inpatient unit. When I’m billing for a follow-up note, and I have a dx list like the following:
Major depressive d/o, severe
Do I have to be actively managing the HTN, DM and sz, in order to be able to bill a 99232 or is the mention of the numerous medical conditions and fact that they are on meds for them enough to warrant the higher code?
A: The key concept here is that you get credit for co-morbid conditions that in any way impact the management of the problems that you are dealing with. So if the seizures themselves, or say the DM medication in any way affect your management of the depression, they are reportable conditions, and hence contribute towards your problem 'count'.
The Feds say:
"1. Demonstrate clearly how physician work (expressed in terms of mental effort, physical effort, time spent and risk to the patient) was affected by co morbidities or chronic problems listed
2. Complexity of documented co-morbidities that clearly influenced physician work"
That's easy for them to say, hard for you to do without more typing than you are likely to do. The best I think we can realistically hope for would be something like 'complicated by' or 'in the setting of' or significant drug interaction potential considered' or something along those lines. I'd encourage you to come up with some one-liners along to this effect.
The second point relative to your question is that to consider any of these problems, we need to see more than the name of the problem listed - we need to see the status. i.e. HTN stable, or better yet stable on Toprol, Seizures on keppra per Neuro. This to indicate that the problems were in part assessed not just named. And in a perfect world a blend of the two - Seizures stable on Keppra, side effects a potential issue with depression - would be great.