Obesity Coding Fact Sheet

Before obesity and/or its complications are diagnosed, do not use “rule out obesity” as the diagnosis. Instead, use as many diagnosis codes as apply to report the patient’s signs and symptoms and/or adverse environmental circumstances and to document the patient’s complexity.

Once obesity and/or its complications are diagnosed, report the appropriate definitive diagnosis code(s) as the primary code, plus as many other symptoms/complications that the patient is exhibiting as secondary diagnoses codes.

Counseling diagnosis codes can be used when the patient is present or when counseling the parent/guardian(s) and the patient is not physically present.

V-codes are used for occasions when circumstances other than a disease or injury are recorded as “diagnoses” or “problems.” Some carriers may request supporting documentation for the reporting of V-codes. 



   Weight gain (abnormal, excessive)
   783.6    Excessive appetite, overeating of unspecified cause
   300.11   Excessive appetite, hysterical 
   308.3      Overeating, as acute reaction to stress
   307.51      Overeating of non-organic origin, bulimia, binge eating
   307.52      Perverted appetite of non-organic origin, pica
   307.59   Overeating, feeding disturbances of infancy
   780.79     Fatigue/lethargy
   701.2       Acanthosis nigricans, acquired
   784.0    Headache, unspecified or vascular
   307.81   Headache, emotional (non-organic origin), tension
   346.9   Headache, migraine (unspecified), without mention of intractable
   346.91   Headache, migraine (unspecified) with intractable migraine
   704.1     Hirsutism
   788.43   Nocturia
   783.5    Polydipsia
   783.6   Polyphagia
   788.42    Polyuria
   V11.9   Unspecified mental disorder
   V21.0     Period of rapid growth in childhood
ICD-9 CODE    PRIMARY DIAGNOSES (related to obesity)  
   278.0   Overweight/obesity (unspecified)
   278.01   Morbid obesity
   307.50   Eating disorder, unspecified
   259.9   Obesity of endocrine origin
   V77.8   Special screening for obesity
   277.7   Dysmetabolic syndrome X
   571.8   Nonalcoholic steatohepatitis
   780.79   Fatigue, general
   244.9   Hypothyroidism, primary or NOS
   V77.0   Screening for thyroid disease
   278.8   Pickwickian syndrome (cardiopulmonary obesity)
   780.57   Sleep apnea, obstructive
   401.9   Hypertension, essential (unspecified)
   401.1   Hypertension, essential (benign)
   405.91   Hypertension, renovascular (unspecified)
   V81.1   Screening for hypertension
   272.4   Hyperlipidemia, unspecified
   272.0    Hypercholesterolemia, pure 
   272.1    Hypertrygliceridemia, pure
   272.2   Mixed hyperlipidemia
   V18.1   Family history of hyperlipidemia
   V77.91   Screening for lipid disorders (cholesterol/HDL/other)
   759.81   Prader-Willi syndrome
   758.0   Down syndrome
   256.4    Polycystic ovary syndrome
   259.1   Precocious puberty
   626.0    Amenorrhea (primary or secondary)
   790.6   Hyperglycemia, NOS
   V77.1   Diabetes, screening
   250.0    Type 2 diabetes mellitus, controlled, no complications
   250.02    Type 2 DM, uncontrolled, no complications
   250.12    Type 2 DM, with ketoacidosis
   250.90    Type 2 DM, with unspecified complications
   251.1   Hyperinsulinemia
   311     Depression, NOS

   Disturbance of emotions specific to childhood/adolescence, with
   misery and unhappiness

   732.4   Blount’s disease (tibia vara)
   732.2    Slipped capital femoral epiphysis
   732.1     Legg-Calvé-Perthes disease
   715.20    Degenerative arthritis, secondary, localized, site unspecified
   715.00     Degenerative arthritis, generalized, site unspecified
   574.3   Gallstones (cholelithiasis)
   575.10   Cholecystitis
   577.0   Pancreatitis
   348.2    Pseudotumor cerebri



Current Procedural Terminology (CPT) Codes

Initial assessment usually involves time to determine the differential diagnosis,
establish a diagnostic plan, and consider potential treatment options. Therefore, most clinicians will report an office/outpatient evaluation and management (E/M) code using time as a key factor or a consultation code for the initial assessment.

Office or Other Outpatient E/M Codes



Use for new patients only; requires 3 of 3 key components or greater than 50% of the visit spent in counseling or coordinating care.



Use for established patients; requires 2 of 3 key components or greater than 50% of the visit spent in counseling or coordinating care. 

Modifier 25

Use for separate, significant physician E/M work that goes above and beyond the physician work normally associated with a service or procedure.

Office or Other Outpatient Consultation Codes





Use for new or established patients; appropriate to report if another physician or other appropriate source (e.g., school nurse, dietitian, psychologist, nurse practitioner) requests an opinion or evaluation of a child who is overweight or obese. Requires 3 of 3 key components or greater than 50% of the visit spent in counseling or coordinating care. 

NOTE: Use of these consultation codes requires the following:

• Written or verbal request for consultation documented in the patient’s chart.

• Consultant’s opinion and physical findings, as well as any services ordered or performed, documented in the chart.

• Consultant’s opinion, physical findings, and any services that are performed prepared in a written report, which is sent to the requesting physician or other appropriate source.

Prolonged Physician Services Codes

99354/99355Use for outpatient face-to-face prolonged services.


Use for non-face-to-face prolonged services in any setting (such as coordinating dietitian, mental health, or other services). 

• Use when a physician provides prolonged services beyond the usual service (e.g., beyond the typical time).

• An alternate to using time as the key factor with the office/outpatient E/M codes (99201–99215).

• Time spent does not have to be continuous.

• Codes are “add-on” codes, meaning they are reported separately in addition to the appropriate code for the service provided (e.g., office or other outpatient E/M codes [99201–99215]).

• If the physician spends at least 30 and no more than 74 minutes beyond the typical time associated with the reported E/M code, he or she can report 99354 (for face-to-face contact) or 99358 (for non-face-to-face contact). Codes 99355 (each additional 30 minutes of face-to-face prolonged service) and 99359 (each additional 30 minutes for non-face-to-face prolonged service) are used to report each additional 30 minutes of service beyond the first 74 minutes.

• Prolonged service of less than 15 minutes beyond the first hour or less than 15 minutes beyond the final 30 minutes is not reported separately.

For more information, please see the American Academy of Pediatrics website: http://www.aap.org/obesity/ObesityCodingFactSheet0208.pdf