1. InSite User Group Call January 10, 2012

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

3. © 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:

4. © OptumInsight, Inc. 4 277.7 Dysmetabolic syndrome X Use additional code(s) for associated condition(s), such as: –Cardiovascular Disease, Heart Failure and Diabetes »414.00 - 414.07 Cardiovascular disease »428.0 - 428.9 Heart failure »250.00 Diabetes type ll or unspecified »250.02 Diabetes type ll or unspecified, uncontrolled »790.29 Pre-diabetes NOS –Overweight & Obesity (Subcategory 278.0x) »278.00 Obesity, unspecified »278.01 Morbid obesity (BMI 40 or greater) »278.02 Overweight (BMI 25-29.9) »278.03 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 2011. Web..

5. © 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 (240-246), 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):356- 359. PMID 11790215 ²Brown, Faye. Faye Brown’s ICD-9-CM Coding Handbook with Answers, 2011. Chicago: AHA Press, 2010 print

6. © 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 ▪278.01 Morbid obesity, unspecified ▪V85.42 BMI 45.0-49.9

7. © 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 40.0-44.9, adult V85.42 BMI 45.0-49.9, adult V85.43 BMI 50.0-59.9, adult V85.44 BMI 60.0-69.9, adult V85.45 BMI 70 and over, adult World Health Organization, Professional: ICD-9-CM for Physicians—Volumes 1 & 2. 2011. Alexandria, VA: Ingenix, 2010, October. Print.