Obesity is considered as a leading public health problem in the United States. Reports suggest that more than two thirds of U.S. adults are overweight or obese. The predominant role of health benefit coverage in reducing the risk of death is undeniable. For instance, obesity is inextricably linked with other serious health conditions including heart disease, diabetes, stroke, and respiratory problems among others. Family practice physicians play a crucial role in understanding and preventing the various challenges faced by obese individuals. By providing proper guidance, these physicians can help individuals to better manage their obesity symptoms and weight management issues, thereby reducing the potential risks of developing other chronic ailments. Obesity screening and counseling is reimbursed and to ensure a streamlined revenue management cycle, physicians can opt for reliable medical billing and coding services.
Medicare Billing for Obesity Screening and Counseling
Medicare pays for obesity screening and behavioral therapy as part of its coverage for preventive services. Obese Medicare beneficiaries can consult a qualified primary care physician for one face-to-face visit every week for the first month, for which they will receive reimbursement. After this, Medicare reimbursement for one face-to-face visit every other week will be provided for the next 2-6 months. Medicare will pay for one face-to-face visit once-a-month for 7-12 months (provided the patient/beneficiaries achieve a weight reduction of at least 3kg (6.6 lbs) during the first six months.
In addition, Medicare advises primary care physicians to use the “5-A framework” that signify “Assess, Advise, Agree, Assist and Arrange” for intensive behavioral intervention. This unique strategy includes assessment of behavioral health risks, counseling about behavioral change and agreement about objectives and strategies. Primary care physicians are also expected to provide full support and ongoing assistance to patients.
It is important for physicians to document their diagnosis and the preventive measures they perform correctly so that during the medical coding process, the coders can assign appropriate diagnostic codes to ensure correct reimbursement. Physicians need to assign qualified and experienced coders for the coding tasks so that medical claims won’t be subject to unnecessary delays due to erroneous coding. To ensure timely claims submission and accurate reimbursement, physicians can seek the help of a professional medical billing and coding company that offers the service of AAPC-certified medical coders.
Medical Codes to Report Obesity
For a 15-minute, face-to-face behavioral counseling for obesity involving Medicare patients, healthcare practices must use the HCPCS code G0447. G0447 must be billed along with correct ICD-9 diagnosis codes ranging from V85.30 to V85.45 on the basis of BMI.
- 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
However, visits shorter than 15 minutes cannot be billed. Obesity screening and counseling can be provided by primary care physicians, advanced practice nurses and physician assistants. Patients need to remain fully alert and competent at the time of counseling.
Obesity Can be Life Threatening
A new study found that being obese or overweight may potentially reduce the life expectancy of people by up to 8 years. The study conducted by researchers at the Institute of the McGill University Health Centre (RI-MUHC) and McGill University in Montreal analyzed the relationship between total body weight and life expectancy.
The study results published in the Journal of Lancet Diabetes & Endocrinology (online issue, December 5, 2014) found that very obese young men and women are more likely to suffer from diabetes and cardiovascular disease for close 20 years and may die 8 years earlier than their normal-weight peers. The more an individual weighs and younger their age, the greater will be the effect of excess weight on health.
As part of the study, researchers developed a computer model to help healthcare professionals and patients recognize how excess body weight reduces life expectancy and leads to premature development of heart disease and diabetes. A discussion was made about how modest lifestyle changes could potentially improve their health.
Researchers utilized data from the Lipid Research Clinic Follow-up study and Atherosclerosis and Risk in Communities (ARIC) study to develop a model to predict the annual risks of developing Type 2 diabetes and cardiovascular disease (if a person had certain risk factors such as high blood pressure and elevated glucose levels). In addition, they used data from the National Health and Nutrition Examination Survey (from years 2003 to 2010) to estimate the risk of developing these co-morbidities in adults (in the age group of 20-79) by age and body mass index (BMI).
The population was divided based on their age group and weight categories. The participants were divided into three age groups (20-39, 40-59 and 60-79 years) and four weight categories such as – normal weight (BMI 18.5 to <25 kg/m2), overweight (BMI 25 to <30 kg/m2), obese (BMI 30 to <35 kg/m2), and very obese (BMI 35 kg/m2 and higher). The key findings of the study include –
- It was found that very obese individuals could potentially lose up to 8 years of life, obese individuals could lose up to 6 years and overweight people could lose up to 3 years.
- Healthy life-years lost were two to four times higher for overweight and obese individuals when compared against those who had a healthy weight (BMI – 18.5-25).
- The age at which excess weight accumulated was a predominant factor and the worst outcomes were in those who gained their weight at earlier stages.
The study results signify that excess weight reduced longevity in both men and women and the effect further lessened with increasing age. Researchers claim that obese young adults suffer more than 50% lifetime risk of developing diabetes and CVD. In addition, those with severe obesity might expect to spend a third of their remaining life with a major chronic condition such as chronic kidney disorder.