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.
|ICD-9 CODE||SIGNS and SYMPTOMS|
|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|
|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|
|V11.9||Unspecified mental disorder|
|V21.0||Period of rapid growth in childhood|
|ICD-9 CODE||PRIMARY DIAGNOSES (related to obesity)|
|307.50||Eating disorder, unspecified|
|259.9||Obesity of endocrine origin|
|V77.8||Special screening for obesity|
|277.7||Dysmetabolic syndrome X|
|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|
|V18.1||Family history of hyperlipidemia|
|V77.91||Screening for lipid disorders (cholesterol/HDL/other)|
|256.4||Polycystic ovary syndrome|
|ICD-9 CODE||SECONDARY DIAGNOSES/COMPLICATIONS|
|626.0||Amenorrhea (primary or secondary)|
|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|
Disturbance of emotions specific to childhood/adolescence, with
|732.4||Blount’s disease (tibia vara)|
|732.2||Slipped capital femoral epiphysis|
|715.20||Degenerative arthritis, secondary, localized, site unspecified|
|715.00||Degenerative arthritis, generalized, site unspecified|
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.|
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
|99354/99355||Use 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