As per the press release published in February 2014 by CDC, obesity prevalence among U.S. children aged 2 to 5 years dropped from about 14 percent in 2003-2004 to over 8 percent in 2011-2012 which points to a decline of 43 percent. The rates were computed on the basis of CDC’s National Health and Nutrition Examination Survey (NHANES) data. The CDC director said that this report came upon the heels of previous CDC data that showed a significant decrease in obesity prevalence among low-income children in the age group 2 to 4 years, who had been participating in federal nutrition programs. He also said there have been signs of obesity prevention programs in various communities around the country such as Anchorage, Alaska, Philadelphia, New York City and King County, Washington. The restrictions imposed by the Obama administration on marketing junk food and sugary drinks in schools are a noticeable approach towards obesity prevention.
The exact reasons for the decline in obesity rates is yet unknown. However, CDC cites some factors that may have played a significant role in reducing the rates. Over the past few years, several child care centers had started to improve the nutrition and physical activity of children. Also, the CDC data shows a decrease in sugar-sweetened beverage consumption among youth in recent years. The other factor is the improvement in breastfeeding rates in the United States as the chance of obesity in breastfed children is much less.
Even though the national study shows a significant drop in obesity rate, certain pediatricians are still concerned about the fight against childhood obesity as per a report published in HeraldNet. They opined although the new study is encouraging, the actual cause of the decline is still unknown. The study itself shows that there is not much progress among older children and hints about the ongoing efforts to keep kids at healthy diets. A study by BMC Health Services Research also points to the importance of primary-care based interventions in preventing childhood obesity. Both of them point towards the role of primary care physicians and pediatricians in reducing obesity rates among children. They should counsel children, recommend effective methods to improve their health behaviors so as to keep them on healthy diets.
However, physicians should document their diagnosis and the preventive measures they perform correctly so that the coders can assign appropriate codes and ensure the due reimbursements.
Codes Used to Report Childhood Obesity
The codes discussed here are only for preventive cases. The severe cases of obesity and treatment procedures are not included.
Diagnosis Codes (ICD-9)
V codes are used when circumstances other than a disease or injury are regarded as “diagnoses” or “problems”
- V18.0: Family history of diabetes mellitus
- V18.1: Family history of endocrine and metabolic diseases
- V49.89: Other specified conditions influencing health status
- V85.51: Body Mass Index, pediatric, less than 5th percentile for age
- V85.52: Body Mass Index, pediatric, 5th percentile to less than 85th percentile for age
- V85.53: Body Mass Index, pediatric, 85th percentile to less than 95th percentile for age
- V85.54: Body Mass Index, pediatric, greater than or equal to 95th percentile for age
- V58.67: Long-term (current) use of insulin
- V58.69: Long-term (current) use of other medications
- V61.0: Family disruption
- V61.20: Counseling for parent-child problem, unspecified
- V61.29: Parent-child problems; other
- V61.49: Health problems with family; other
- V61.8: Health problems within family; other specified family circumstances
- V61.9: Health problems within family; unspecified family circumstances
- V62.81: Interpersonal problems, not elsewhere classified
- V62.89: Other psychological or physical stress not elsewhere classified; other
- V62.9: Unspecified psychosocial circumstance
- V65.19: Other person consulting on behalf of another person
- V65.3: Dietary surveillance and counseling
- V65.41: Exercise counseling
- V65.49: Other specified counseling
- V69.0: Lack of physical exercise
- V69.1: Inappropriate diet and eating habits
- V69.8: Other problems relating to lifestyle; self-damaging behavior
- V69.9: Problem related to lifestyle, unspecified
Procedure Codes
CPT Codes
Health and Behavior Assessment/Intervention Codes
- 96150: Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; initial assessment
- 96151: Health and behavior assessment (eg, health-focused clinical interview, behavioral observations, psychophysiological monitoring, health-oriented questionnaires), each 15 minutes face-to-face with the patient; re-assessment
- 96152: Health and behavior intervention, each 15 minutes, face-to-face; individual
- 96153: Health and behavior intervention, each 15 minutes, face-to-face; group (2 or more patients)
- 96154: Health and behavior intervention, each 15 minutes, face-to-face; family (with patient present)
- 96155: Health and behavior intervention, each 15 minutes, face-to-face; family (without patient present)
Medical Nutrition Therapy Codes
- 97802: Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with patient, each 15 minutes
- 97803: Medical nutrition therapy; re-assessment and intervention, individual, face-to-face with the patient, each 15 minutes
- 97804: Medical nutrition therapy; group (2 or more individuals), each 30 minutes
HCPCS Codes
Education and Counseling Codes
- S9445: Patient education, not otherwise classified, non-physician provider, individual, per session
- S9446: Patient education, not otherwise classified, non-physician provider, group, per session
- S9449: Weight management classes, non-physician provider, per session
- S9451: Exercise class, non-physician provider, per session
- S9452: Nutrition class, non-physician provider, per session
- S9454: Stress management class, non-physician provider, per session
- S9455: Diabetic management program, group session
- S9460: Diabetic management program, nurse visit
- S9465: Diabetic management program, dietician visit
- S9470: Nutritional counseling, dietician visit
It is very important for physicians to have knowledgeable and experienced coders for assigning the codes correctly according to the documentation so that their claims won’t be subject to unnecessary delays due to inappropriate coding. Since even minor coding mistakes can be really expensive, physicians can seek the help of a professional medical billing and coding company that offers the service of AAPC-certified medical coders.
