Obesity is a serious medical concern. According to the World Health Organization (WHO), worldwide obesity has nearly tripled since 1975. World Obesity Day is observed annually on October 11 to highlight the environmental and medical factors contributing to high obesity rates. Overweight and obesity are amongst America’s most pressing public health problems. Obesity increases the risk for serious diseases such as cancer, diabetes, heart and disease. It is also a risk factor for many gastrointestinal conditions. Treating obesity is as complex as the condition itself is. In fact, in recent years, gastroenterologists have been increasingly involved in treating obese patients. A gastroenterology medical billing company can help gastroenterology practices manage the coding and billing for these services.
Obesity and Body Mass Index (BMI)
The Centers for Disease Prevention and Control (CDC) defines obesity as follows: “Weight that is higher than what is considered as a healthy weight for a given height”.
Physicians use body mass index(BMI) and waist circumference to determine if a person is at an appropriate weight for their age, sex, and height. According to the CDC, a BMI between 25 and 29.9 indicates that a person is overweight, while a BMI of 30 or over suggests that a person may have obesity.
The CDC adult BMI chart is as follows:
- BMI less than 18.5 – underweight
- BMI18.5 to <25 – normal
- BMI 25.0 to <30 – overweight
- BMI 30.0 or higher – obese
A report from the American Medical Association had cited a study indicating that the nation’s obesity rate was close to 40 percent in 2018, a 5 percent increase from the range of 34–35 percent between 2005 and 2012. Obesity is taking its toll on adults as well as children.
Coding for Obesity and BMI
When coding for obesity, both the obesity diagnosis as well as BMI should be coded.
ICD-10 Obesity Codes:
- E66.1 Drug-induced obesity
- E66.2 Severe obesity with alveolar hypoventilation
- E66.3 Overweight
- E66.8 Other obesity
- E66.9 Obesity, unspecified
BMI Codes Z68
- Z68.20 – Body Mass Index (BMI) 20.0-20.9, adult
- Z68.25-29.9 Body mass index (BMI) 25-29.9, adult
- Z68.30-Z68.39 Body mass index (BMI) 30.0-39.9, adult
- Z68.4 Body mass index (BMI) 40 or greater, adult
- Z68.41 Body mass index (BMI) 40.0-44.9, adult
- Z68.42 Body mass index (BMI) 45.0-49.9, adult
- Z68.43 Body mass index (BMI) 50-59.9, adult
- Z68.44 Body mass index (BMI) 60.0-69.9, adult
- Z68.45 Body mass index (BMI) 70 or greater, adult
- The BMI number included in the code description is a weight/height calculation, butshould be coded correctly based on the patient’s age.
The 2019 ICD-10-CM Official Guidelines state that BMI codes cannot be used alone and should be only assigned when the associated diagnosis (such as overweight or obesity) meets the definition of a reportable diagnosis. The provider must provide documentation of a clinical condition such as obesity or overweight to validate the reporting of a code for BMI (www. medicaleconomics.com).
Gastrointestinal Symptoms and Disorders linked to Obesity
Overeating is a major cause of obesity and controlling food intake is a major consideration for weight control. Intake of food is associated with major changes in gastric motor function. This is why obesity is associated with many gastrointestinal complications. Nonalcoholic fatty liver disease is directly caused by obesity. Other digestive disorders associated with obesity are:
- Gastroesophageal reflux disease
- Barrett’s esophagus
- Esophageal adenocarcinoma
- Erosive gastritis
- Gastric cancer
- Acute pancreatitis
- Pancreatic cancer
- Colonic diverticular disease
- Colon polyps
- Nonalcoholic fatty liver disease
- Hepatocellular carcinoma
- Acute pancreatitis
A report published in 2017 in The Lancet noted that while patients seek medical care for their gastrointestinal problems, their underlying obesity is usually goesunaddressed.
AGA Obesity Practice Guide calls for a Collaborative Approach
Given the wide range of gastrointestinal symptoms and disorders associated with obesity, gastroenterologists are uniquely positioned to lead a care team for obese patients. In March 2017, the American Gastroenterological Association (AGA) released an “Obesity Practice Guide” to provide gastroenterologists with a comprehensive, multidisciplinary process to lead safe and effective weight management for obese patients.
The AGA guide provides a comprehensive obesity care model for a gastroenterology practice. This includes patient goal setting, readiness assessment, evaluation, and treatment with diet, medication, and bariatric endoscopy and surgery. The various phases in the care plan are as follows:
- Initial consultation
- Assessing patient readiness for intervention and managing the overall disease burden
- Dietary and physical activity assessment
- Medical assessment of both risk factors for obesity and the complications of disease psychological evaluation.
- Dietary adjustments
- Physical activity and behavioral counseling
- For select patients – weight loss with pharmacotherapy followed by endoscopic therapy, surgical management, or both (as needed)
- Follow-up care
- Weight loss maintenance
- weight gain–regain prevention
These guidelines emphasize that the success of the obesity care plan depends on a collaborative approach witha multidisciplinary team of dietitians, exercise therapists, nurse educators, psychologists and physicians.
Obesity spurs Demand for Gastrointestinal (GI) Procedures
Gastroenterologists diagnose and treat a variety of gastrointestinal symptoms and disorders seen in obese individuals and also in the primary treatment of obesity. Medscape reported that the increased prevalence of GI symptoms and disorders in obese individuals has increased the demand for endoscopic and other gastrointestinal (GI) procedures.
GI endoscopy plays a crucial role in the preoperative, intraoperative and importantly, postoperative management of bariatric surgery patients. It is recommended that upper GI system endoscopy is performed in all patients to predict and prevent complications following bariatric surgery. The procedure can identify upper GI symptoms, histal hernias and gastritis.
Bariatric endotherapy is a less invasive, safe and effective endoscopic alternative to bariatric surgery. Medscape lists the uses of bariatric endotherapy in the treatment of obesity as:
- a primary therapy to induce weight loss and improve obesity-related comorbidities
- a bridge to surgery in high-risk, severely obese individuals who may not otherwise be candidates forsurgery
- a metabolic therapy where the main goal is improvement in the metabolic disorders (such as type 2 diabetes, hyperlipidemia, hypertension) with only modest weight loss as a goal
As gastroenterology practices become increasingly involved in the integrated care of obese patients, the support of an experienced medical billing company can prove invaluable to report their services for correct and timely reimbursement.