Do obese patients face discrimination in the physician’s office? Sadly, studies and surveys seem to say yes, they do. As a medical billing company, we provide a large volume of medical coding services for healthcare providers who specialize in treating patients who are obese.
According to a Huffington Post report published in November 2016, a survey of nearly 3,000 adults with overweight and obesity-related disorders said that doctors were the second most common source of weight stigma, coming after family members. While being overweight does increase a person’s risk for many health problems, including those that are serious, patient experiences of weight stigma are not superficial and cannot be overlooked.
A Johns Hopkins research study published in 2013 suggested that thin patients are treated with more warmth and empathy than those who are overweight or obese. Another study on nurses’ attitudes reported that almost a quarter of the respondents felt “repulsed” by obese patients and more than one-third said they would prefer not to treat patients with obesity. One study found that patient-physician communication suffers when the patient is obese as primary care physicians have poorer emotional connect with patients who are overweight.
Such attitudes can affect care as studies show that patients tend to heed their physician’s advice and experience better health outcomes when the physician empathizes with their plight. The number of Americans suffering from obesity is increasing and physicians need to recognize the extent to which obesity and its complications affect patient health. The fact is that obesity is a complex condition and not just a matter of willpower.
When it comes to care, providers should follow established guidelines when treating patients who are obese. They need to conduct a comprehensive examination to determine if the patient’s condition is obesity-related or not. For instance, an orthopedist should not conclude that the patient’s musculoskeletal pain is obesity-related without performing a proper evaluation. Moreover, providers should be well-informed about payer rules for medical billing and coding for obesity-related treatment, as these rules have undergone significant changes in recent years.
Here are some important coding considerations related to obesity treatment:
- Documentation is the key when coding morbid obesity under ICD-10. Proper reimbursement depends on specific and complete diagnosis coding to support medical necessity for the service as described by the Current Procedural Terminology (CPT) code linked to the diagnosis.
- Many of the ICD-10 codes have multiple codes for particular conditions.
- According to the National Coverage Determination (NCD) for Treatment of Obesity, Medicare pays for services provided in connection obesity treatment when such services are a fundamental and necessary part of a course of treatment for conditions such as hypothyroidism, Cushing’s disease, hypothalamic lesions, cardiovascular diseases, respiratory diseases, diabetes, and hypertension.
- Reimbursement depends on the key components (history, examination, and medical-decision-making) of the problem-oriented Evaluation and Management (E/M) service or the appropriate screening code. A problem oriented E/M service may be reported if more than 50% of total time was spent on patient counseling.
- Hierarchical Condition Category or HCC coding for morbid obesity will trigger increased payment considerations for the treating facility. This is because treating an obese or morbidly obese patient may require extra work and cost, along with other acute or chronic conditions being treated at that time.
Here are the ICD-10 codes commonly reported for screening and treating obesity:
- Obesity screening – Z13.89
- Obesity (not otherwise specified) – E66.9
- Obesity, extreme or morbid – E66.01
- Obesity due to excess calories – E66.0
- Morbid (severe) obesity due to excess calories – E66.01
- Other obesity due to excess calories – E66.09
Drug-induced obesity – E66.1 - Morbid (severe) obesity with alveolar hypoventilation – E66.2
- Overweight – E66.3
- Other obesity – E66.8
- Obesity, unspecified – E66.9
In procedure coding, the most appropriate E/M code to select will depend on whether the encounter was for screening or treatment of obesity. If the encounter was for patient screening, a preventive medicine code from the following code sections should be reported:
- Preventive medicine, individual counseling – 99401-99404
- Preventive medicine, group counseling – 99411-99412
According to a 2015 national survey of family physicians, internists, OB/GYN physicians, and nurse practitioners (NPs), while only 9 percent reported coding for behavioral counseling, 31 percent reported that they never prescribe obesity drugs, and 11 percent that they never recommend bariatric surgery. Physicians need to overcome their bias towards patients with obesity. Medical coding outsourcing can make coding for obesity and common comorbidities much easier. With in-depth and up-to-date knowledge of ICD-10 and CPT codes and payer rules, reliable medical coding and billing companies can efficiently support providers in empowering and supporting patients with obesity, and in getting appropriately reimbursed for their services.
