ICD-10 Coding for Morbid Obesity(E66.01, E66.2)
Complete ICD-10-CM coding and documentation guide for Morbid Obesity. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Morbid Obesity
E66.0-E66.9Primary Range
Obesity and other hyperalimentation
This range includes codes for various types of obesity, including morbid obesity, which is the primary focus.
Body mass index (BMI) 40.0-70 and over, adult
These codes are used to specify the BMI of patients diagnosed with obesity.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| E66.01 | Morbid (severe) obesity due to excess calories | Use when the provider documents 'morbid obesity' and the patient has a BMI ≥40 or BMI ≥35 with comorbid conditions. |
|
| E66.2 | Morbid obesity with alveolar hypoventilation | Use when morbid obesity is complicated by alveolar hypoventilation. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for morbid obesity
Essential facts and insights about Morbid Obesity
Primary ICD-10-CM Codes for morbid obesity
Decision Criteria
clinical Criteria
- BMI ≥40 or BMI ≥35 with comorbidities
documentation Criteria
- Provider must document 'morbid obesity'
Applicable To
- Morbid obesity with BMI ≥40
- Morbid obesity with BMI ≥35 and comorbidities
Excludes
- Obesity due to drugs (E66.1)
Clinical Validation Requirements
- BMI ≥40 or BMI ≥35 with comorbidities
- Provider documentation of 'morbid obesity'
Code-Specific Risks
- Coding based solely on BMI without provider diagnosis
Coding Notes
- Ensure provider documentation explicitly states 'morbid obesity' for accurate coding.
E66.2 - Morbid obesity with alveolar hypoventilation
Use when morbid obesity is complicated by alveolar hypoventilation.
Applicable To
- Obesity hypoventilation syndrome
Excludes
- Sleep apnea (G47.33)
Clinical Validation Requirements
- Daytime hypercapnia (PaCO2 ≥45 mmHg) with BMI ≥30
Coding Notes
Ensure documentation supports both obesity and hypoventilation.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
BMI 40.0-44.9, adult
Z68.41Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Morbid Obesity to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code E66.01.
Impact
Clinical: May lead to under-treatment of obesity-related conditions., Regulatory: Non-compliance with coding guidelines., Financial: Potential loss of reimbursement due to incorrect coding.
Mitigation Strategy
Educate providers on the importance of documenting diagnoses., Implement EHR prompts for obesity diagnosis when BMI is high.
Impact
Reimbursement: Incorrect DRG assignment leading to potential underpayment., Compliance: Non-compliance with ICD-10 coding guidelines., Data Quality: Inaccurate clinical data representation.
Mitigation Strategy
Always use an obesity code (E66.xx) as the primary diagnosis.
Impact
Discrepancies between documented BMI and diagnosis of obesity.
Mitigation Strategy
Ensure provider documentation aligns with BMI and diagnosis.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Morbid Obesity, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Morbid Obesity
Use these documentation templates to ensure complete and accurate documentation for Morbid Obesity. These templates include all required elements for proper coding and billing.
Initial assessment of a patient with suspected morbid obesity
Specialty: Internal MedicineRequired Elements
- BMI calculation
- Provider assessment of obesity status
- Documentation of comorbid conditions
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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