By: Valentina Gallegos, BA, CPC
Did you know!?
Each 0.1 increase in RAF is worth $900 to $1000? Let’s work to accurately code to the highest specificity!
Today, let’s discuss:
- E66.01 Morbid Obesity due to excess calories and the opposite E44.0 Moderate protein-calorie malnutrition
- E66.01 Morbid Obesity due to excess calories
- Maps to HCC22 – Morbid Obesity
- Value 0.244
When BMI is 35 or greater WITH one of the below conditions, ICD-10-CM guidelines allow you to assess and bill E66.01.*
- Heart Disease
- DM II
- CA
- HTN
- Dyslipidemia
- Liver and Gallbladder Disease
- Depression
- Sleep Apnea
- Respiratory Conditions
- Osteoarthritis
- GYN problems
- Stroke
When BMI is 40 or greater you can assess and bill E66.01 without any co-existing conditions.
As some Providers are hesitant on billing E66.01; in the case of BMI being 40 or greater, you may instead, bill the Z68.4- category codes as they map to the same HCC category and hold the same value.
Z68.41 – BMI 40.0- 44.9
Maps to HCC22
Value 0.244
*Please Note: This same Z68 technique will not work for BMI 35 with the above co-existing conditions, as the Z68 codes for BMI 35 – 39 do not map to an HCC and therefore do not risk adjust. For these scenarios E66.01 must be billed to capture the HCC weight and value for that patient’s care.
E44.0 Moderate Protein-Calorie Malnutrition
E44.1 Mild protein-calorie malnutrition
Maps to HCC21
Value 0.493 (Holds two times the value than E66.01!)
Malnutrition is considered such a liability that it risk adjusts at twice the value of morbid obesity.
If your patient’s BMI is 18.5 or lower, OR you notice the patient’s BMI is steadily declining, it reflects a risk that Physicians should note and act upon. Be sure to document the discussion, any care plans, and any diagnosis associated with weight loss as well as any cause for it.
Low BMI’s associated with malnutrition or cachexia do not of themselves risk-adjust and are insufficient for reporting the patient’s condition without a weight-related malnutrition diagnosis. The diagnosis and care plan must be documented.
Documentation Tips:
- Choose clear and concise language
- State “malnutrition” instead of “malnourished”
- State “cachexia” rather than “cachectic”
- Differentiate between cachexia and sarcopenia
- If a patient’s weight is causing other health issues (anemia or falls), document the health issues and link them to the malnutrition (weight) diagnosis
| Nonspecific Documentation | Specific Documentation |
| Patient’s pancreatic cancer has advanced. I have suggested parenteral feeding but patient declines. | Patient’s pancreatic cancer has metastasized to the peritoneum and liver. I have suggested parenteral feeding to address her severe malnutrition, but she declines. |
| Patient has developed wasting disease | Patient has developed wasting disease with a current BMI of 15.8. The main goal is to keep her hydrated and comfortable in her end-stage COPD. She is receiving morphine for her dyspnea. |
Although BMI is an important quality measure tool, the ICD-10-CM codes for BMI should only be reported when a weight diagnosis is documented: such as overweight, obesity, morbid obesity, and malnutrition.
In the case of E44.0 and E44.1 you may also assess and bill
Z68.1 BMI 19.9 or less, adult (does not risk adjust, but gives highest specificity to patient’s health status)
