CODING & DOCUMENTATION

Have them sign a notice only if the services, as provided, are clearly not covered by the patient’s policy. Payers may not cover this as an E/M visit, but under federal law most insurance plans must cover obesity counseling as a preventive service for patients with a body mass index (BMI) of 30 or higher. Though the law does not require plans to cover these services for patients who are overweight (BMI of 25–29), some may anyway.

To avoid denials, report these visits with preventive medicine counseling codes 99401-99404 or an appropriate HCPCS code (for Medicare patients, see requirements for reporting intensive behavioral therapy for obesity¹). Most plans require diagnosis codes for obesity (from the E66.- category or E88.82) and BMI (Z68.30 through Z68.44).

Practice staff should review payer policies for preventive services to determine their specific requirements for reporting these codes. They may include using the “Five A’s” — assess, advise, agree, assist, arrange — and a certain frequency or duration of services. Most counseling codes are time-based, so payers may require documentation of face-to-face or in-person time.

As a practical matter, it may be rare that patients presenting with obesity don’t also have another complaint or problem related to it (e.g., joint pain, prediabetes, or obstructive sleep apnea). Talking to patients about how their weight is affecting their life might surface these conditions, which could make for more effective care, as well as qualify the encounter to be reported as an E/M visit.

No. Prediabetes code R73.03 indicates that the patient has hyperglycemia or impaired fasting glucose that is not at a level supporting a type 2 diabetes mellitus diagnosis. For presymptomatic type 1 diabetes mellitus, report the appropriate code from E10.A0-E10.A2.

Report a code from category I11.- for hypertensive heart disease. ICD-10 instructs clinicians to not report an additional code for cardiomegaly, and this instruction also applies to myocardial degeneration in hypertensive heart disease. However, when you report I11.0 for hypertensive heart disease with heart failure, you should also report a code from category I50.- to identify the type of heart failure.