InSite User Group Call January 10, 2012

Presented by: Toni Toone, CPC, CPMA Focus on: Obesity & Metabolic Syndrome

© OptumInsight, Inc. 3 Obesity & Metabolic Syndrome Evaluate, Diagnose and Treat  Weight loss 5-10% makes a difference  Lifestyle change  Limit fat intake  Increase consumption of fruit and vegetables, legumes, whole grains and nuts  Limit intake of sugars  Physical activity Grundy, SM, et al. Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung and Blood Institute Scientific Statement:Executive Summary. Circulation 2005;112:e285-e290.  Various strategies have been proposed to prevent the development of metabolic syndrome, which include:

© OptumInsight, Inc Dysmetabolic syndrome X Use additional code(s) for associated condition(s), such as: –Cardiovascular Disease, Heart Failure and Diabetes » Cardiovascular disease » Heart failure » Diabetes type ll or unspecified » Diabetes type ll or unspecified, uncontrolled » Pre-diabetes NOS –Overweight & Obesity (Subcategory 278.0x) » Obesity, unspecified » Morbid obesity (BMI 40 or greater) » Overweight (BMI ) » Obesity hypoventilation syndrome. Documentation & Coding Tips “CMS and the National Center for Health Statistics (NCHS).” ICD-9-CM Official Guidelines for Coding and Reporting. N.p., 01 oct Web..

© OptumInsight, Inc. 5 Documentation Tips  The diagnosis of overweight & obesity: –While BMI may be coded from the dietician’s or other caregiver’s documentation, the diagnosis of being overweight or obese must be coded from the provider’s documentation ¹  Obesity due to a specified cause, –such as Thyroid disorder ( ), is coded to the underlying condition ² ¹ Ford ES, Giles WH, Dietz WH (2002). Prevalence of metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 287(3): PMID ²Brown, Faye. Faye Brown’s ICD-9-CM Coding Handbook with Answers, Chicago: AHA Press, 2010 print

© OptumInsight, Inc. 6 Documentation & Coding Tips  Example: A patient is seen in the endocrinologist’s office and diagnosed with Dysmetabolic Syndrome X and morbid obesity. BMI calculation 46 ▪277.7 Dysmetabolic syndrome X ▪ Morbid obesity, unspecified ▪V85.42 BMI

© OptumInsight, Inc. 7 Obesity Reporting: BMI Age 40+  Use additional code to identify Body Mass Index (BMI) if known:  For members with BMIs of 40 and over, adult: V85.41 BMI , adult V85.42 BMI , adult V85.43 BMI , adult V85.44 BMI , adult V85.45 BMI 70 and over, adult World Health Organization, Professional: ICD-9-CM for Physicians—Volumes 1 & Alexandria, VA: Ingenix, 2010, October. Print.