Complete Revenue Cycle Management for
Medical & Dental Clinics, Practices and Hospitals

  • Shared Vision: Your Business is our Business
  • Cloud Based Billing Software or Work on Yours
  • Certified Coders: ICD 10 Coders
  • Real Support with Dedicated Managers
Contact OSI Today!
Ask about our free trial to see firsthand how our services can benefit your practice.

Obesity in AdultsObesity is considered as a leading public health problem globally. The rates of obesity have increased significantly over the past few years in the United States. It is estimated that more than two thirds of the US adults are overweight or obese. This condition is directly linked to other serious health conditions including heart disease, diabetes, stroke, and respiratory problems. Recent research suggests that the risk of developing many cancers and dying from them is higher among people who are overweight.

According to the 2014 Cancer Progress Report from the American Association for Cancer Research (AACR), increased body weight is directly responsible for nearly 25% of the cancer cases (which ranks second to tobacco use). However, when this factor is combined with related behaviors, including a lack of physical activity and poor diet, the relative contribution rises to 33% of newly diagnosed cancer cases in the U.S.

Obesity Increases Women’s Cancer Risk – Finds Study

A new study found that obese women have 40% higher risk of developing cancer in their lifetime than thinner women. The study conducted by Cancer Research UK reports that One out of four women who are overweight is at risk of developing a cancer linked to their body weight in their lifetime. This increase could expose the woman to seven types of cancer, including bowel, kidney, uterus, gallbladder, pancreas and esophagus, as well as post-menopausal breast cancers.

As part of the study, researchers analyzed a group of 1000 obese women. It was found that about 274 women were diagnosed with a body-weight-linked cancer in their lives when compared against 194 women diagnosed in a group of 100 healthy weight women.

The study results signify that excess weight may increase the chances of cancer developing in women. It highlights the fact that excess body weight can result in fat cells’ production of hormones, especially estrogen, which is believed to stimulate cancer development. The risk of developing this disease depends on a combination of different factors such as genes, environment and lifestyle habits. Making significant or positive changes in your lifestyle such as quitting the habit of smoking, maintaining a healthy weight, eating a balanced diet and cutting back on alcohol will help you reduce the potential risk of cancer. Reducing body weight is not an easy task. People need to incorporate higher physical activity into their lifestyle. Rigorous physical exercises combined with a healthy diet can help in better weight management.

Medicare Reimbursement for Obesity Screening and Counseling

Family practice physicians play an important role in helping to prevent the various risks faced by obese adults. These physicians provide adequate guidance to people that help them to better manage obesity symptoms, weight management issues and lower the potential risks of developing other chronic diseases.

Medicare provides coverage for obesity screening and behavioral therapy as part of its preventive services. Obese Medicare beneficiaries can consult a primary care physician or other primary care practitioner for counseling. The coverage is provided for

  • One face-to-face visit every week for the first month
  • One face-to-face visit every other week for months 2-6
  • One face-to-face visit every month for 7-12 months, if the beneficiary meets the 3kg (6.6 lbs) weight loss requirement as discussed below)

Medicare advises primary care physicians to follow the 5-A framework” that indicate “Assess, Advise, Agree, Assist and Arrange” for intensive behavioral intervention. This strategy includes assessment of behavioral health risks, counseling about behavioral change and agreement about objectives and strategies. Primary care physicians are required to provide complete support and assistance to patients.

Physicians need to accurately document their diagnosis and the preventive services they perform so that coders can assign the correct diagnostic and procedural codes to ensure correct reimbursement. It is important to assign coding tasks to qualified coders so that the medical claims submitted to payers don’t get delayed due to erratic coding. Physicians can seek the help of a professional medical billing and coding company that offers the service of AAPC-certified medical coders.

Codes Used to Report Obesity

The HCPCS code G0447 is to be reported for a 15-minute, face-to-face behavioral counseling for obesity involving Medicare patients. This code must be billed along with ICD-9 diagnosis codes ranging from V85.30 to V85.45 which are classified on the basis of BMI.

ICD-9 codes

  • BMI of 30.0–30.9 – V85.30
  • BMI of 31.0–31.9 – V85.31
  • BMI of 32.0–32.9 – V85.32
  • BMI of 33.0–33.9 – V85.33
  • BMI of 34.0–34.9 – V85.34
  • BMI of 35.0–35.9 – V85.35
  • BMI of 36.0–36.9 – V85.36
  • BMI of 37.0–37.9 – V85.37
  • BMI of 38.0–38.9 – V85.38
  • BMI of 39.0–39.9 – V85.39
  • BMI of 40.0–44.9 – V85.41
  • BMI of 45.0–49.9 – V85.42
  • BMI of 50.0–59.9 – V85.43
  • BMI of 60.0–69.9 – V85.44
  • BMI of 70 or more – V85.45

ICD-10 codes

  • BMI of 30.0-30.9, adult – Z68.30
  • BMI of 31.0-31.9, adult – Z68.31
  • BMI of 32.0-32.9, adult – Z68.32
  • BMI of 33.0-33.9, adult – Z68.33
  • BMI of 34.0-34.9, adult – Z68.34
  • BMI of 35.0-35.9, adult – Z68.35
  • BMI of 36.0-36.9, adult – Z68.36
  • BMI of 37.0-37.9, adult – Z68.37
  • BMI of 38.0-38.9, adult – Z68.38
  • BMI of 39.0-39.9, adult – Z68.39
  • BMI of 40.0-44.9, adult – Z68.41
  • BMI of 45.0-49.9, adult – Z68.42
  • BMI of 50.0-59.9, adult – Z68-43
  • BMI of 60.0-69.9, adult – Z68.44
  • BMI of 70.0 or more, adult – Z68.45

It is important to note that visits shorter than 15 minutes cannot be billed. Obesity screening and counseling are provided by primary care physicians, physician assistants and advanced practice nurses and hence the patient should remain fully alert and competent during the time of counseling.