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It just doesn't make sense, does it?
Obesity is associated with increased mortality and morbidity. ICD-9 codes exist for the condition. But when you use those codes on reimbursement paperwork, you may not get paid.
The Academy is working hard to change that.
Board Chair James Martin, M.D. of San Antonio pounded home a clear message in letters sent to three national organizations recently: “Obesity is an illness for which prevention and reasonable and necessary diagnosis and treatment should be covered.”
The AAFP sent the letters to the American Association of Health Plans, Washington Business Group on Health, and Centers for Medicare & Medicaid Services.
Martin cited published rationale for recognizing obesity as an illness, including ICD-9 codes covering unspecified obesity and morbid obesity.
Despite that, current Medicare policy states “obesity is not considered an illness, ” said Martin in urging CMS to reassess its position.
As further ammunition to bolster the AAFP’s position, Martin cited sources from the National Heart, Lung and Blood Institute; FDA; and the Internal Revenue Service. All three recognize obesity as a disease.
In addition, strong clinical evidence shows that obesity is associated with increased mortality and morbidity and that weight loss in obese individuals can reduce risk factors for diabetes and cardiovascular disease, said Martin.
He listed additional ailments associated with obesity, including stroke, gallstones, gout, female reproductive problems, poor bladder control and psychological disorders.
“In short, the prevention and treatment of obesity can contribute positively to the prevention and treatment of many other illnesses for which health plans cover diagnosis and treatment,” he said.
The letters also made the economic case for prevention and treatment of obesity (see "Economic Implosion on Tap: Physicians, Public Health Agencies Must Curb America's Girth"). Martin said CDC resources showed the cost of obesity in the United States was more than $117 billion in 2000.
To reach writer Sheri Porter, e-mail sporter@aafp.org.
FP Report is published by the
AAFP News Department.
Copyright © 2004 by
American Academy of Family Physicians.