According to a study conducted by researchers at the University of South Carolina’s Arnold School of Public Health, obese men and women in U.S. spend less than one minute a day in vigorous activity whereas more than 15 hours are spent each day for sleeping and sitting. If the federal recommendation is at least 2.5 hours of moderate-intensity aerobic exercise every week to maintain the ideal weight, the research suggests that just 30 minutes of exercise five days a week is enough. The time spent by obese Americans for exercise is thus too much lower than these figures. This gives us a hint why obesity rates remain high in the United States.
According to Edward Archer who led the study, physicians and researchers used questionnaires in the past to obtain the estimates of physical activity, exercise, sedentary behavior, and diet which rarely provided accurate or reliable data. The public health policy and food-based guidelines developed without valid estimates are ineffective. However, the researchers used an accelerometry based technology to validate Physical Activity Ratio (PAR) protocol which provided first nationally representative estimates of total daily energy expenditure, physical activity and sedentary behavior for the U.S. population.
Vigorous exercises are normally defined as fat-burning physical activities including jogging. Some experts say it is relative to the fitness level of an individual. Walking could be a vigorous exercise for certain obese people. However, it is very important to consult with a doctor about what types of activities are safe especially if there is a heart problem or chronic disease or there arise symptoms including chest pain or dizziness while performing the physical activities. Intensive behavioral therapy is therefore much helpful, which involves screening for obesity, dietary assessment and behavioral counseling and therapy that promote sustained weight loss through high intensity interventions on diet and exercise.
Obesity treatment codes are reimbursed for physicians. Let us look at some of these medical codes.
Medical Coding – Intensive Behavioral Therapy for Obesity (Medicare)
Procedure Codes (CPT and HCPCS)
Behavioral Counseling
- G0447: Face-to-face behavioral counseling for obesity, 15 minutes
Health Risk Assessment
- 99420: Administration and interpretation of health risk assessment instrument
Preventive Medicine Counseling
- 99401: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes
- 99402: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 30 minutes
- 99403: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 45 minutes
- 99404: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 60 minutes
- 99411: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 30 minutes
- 99412: Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure); approximately 60 minutes
Evaluation and Management (New Patient)
- 99202: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: an expanded problem focused history; an expanded problem focused examination; straightforward medical decision making.
- 99203: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a detailed history; a detailed examination; medical decision making of low complexity.
- 99402: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity.
- 99205: Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity.
Evaluation and Management (Established Patient)
- 99212: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making.
- 99213: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity.
- 99214: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity.
- 99215: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a comprehensive history; a comprehensive examination; medical decision making of high complexity.
Diagnosis Codes
G0447 must be billed along with any one of the ICD-9 codes for BMI 30.0 and over
- V85.30: Body Mass Index 30.0-30.9, adult
- V85.31: Body Mass Index 31.0-31.9, adult
- V85.32: Body Mass Index 32.0-32.9, adult
- V85.33: Body Mass Index 33.0-33.9, adult
- V85.34: Body Mass Index 34.0-34.9, adult
- V85.35: Body Mass Index 35.0-35.9, adult
- V85.36: Body Mass Index 36.0-36.9, adult
- V85.37: Body Mass Index 37.0-37.9, adult
- V85.38: Body Mass Index 38.0-38.9, adult
- V85.39: Body Mass Index 39.0-39.9, adult
- V85.41: Body Mass Index 40.0-44.9, adult
- V85.42: Body Mass Index 45.0-49.9, adult
- V85.43: Body Mass Index 50.0-59.9, adult
- V85.44: Body Mass Index 60.0-69.9, adult
- V85.45: Body Mass Index 70 and over, adult
ICD-10 codes (effective from October 1, 2014)
- Z68.30: Body Mass Index 30.0-30.9, adult
- Z68.31: Body Mass Index 31.0-31.9, adult
- Z68.32: Body Mass Index 32.0-32.9, adult
- Z68.33: Body Mass Index 33.0-33.9, adult
- Z68.34: Body Mass Index 34.0-34.9, adult
- Z68.35: Body Mass Index 35.0-35.9, adult
- Z68.36: Body Mass Index 36.0-36.9, adult
- Z68.37: Body Mass Index 37.0-37.9, adult
- Z68.38: Body Mass Index 38.0-38.9, adult
- Z68.39: Body Mass Index 39.0-39.9, adult
- Z68.41: Body Mass Index 40.0-44.9, adult
- Z68.42: Body Mass Index 45.0-49.9, adult
- Z68.43: Body Mass Index 50.0-59.9, adult
- Z68.44: Body Mass Index 60.0-69.9, adult
- Z68.45: Body Mass Index 70 and over, adult
Medicare will pay G0447 claims only if the services are submitted by the appropriate provider specialty types and place of service found on the provider’s Medicare enrollment record. This is applicable for the services on or after November 29, 2011.
Provider Specialty Types
- 01: General Practice
- 08: Family Practice
- 11: Internal Medicine
- 16: Obstetrics/Gynecology
- 38: Geriatric Medicine
- 50: Nurse Practitioner
- 89: Certified Clinical Nurse Specialist
- 97: Physician Assistant
Place of Service Codes
- 11: Physician’s Office
- 22: Outpatient Hospital
- 49: Independent Clinic
- 71: State or local public health clinic
Physicians should be careful about the documentation and codes assigned before submitting Medicare claims for intensive behavioral therapy to receive reimbursement in time. Any minor mistake may result in the denial of claims. Since the documentation guidelines and codes may vary with individual health insurance plans, physicians should perform insurance benefit verification before giving an appointment for the patient. They can seek help from a professional medical billing and coding company that offers the service of AAPC certified coders and billers for insurance verification, billing, coding and for taking care of the entire revenue cycle management.
