JANUARY 2011

Informative and educational updates for providers

FOCUS ON: THE metabolic Always Remember…

syndrome • While BMI may be coded from the dietician’s or other 1 caregiver’s documentation, the diagnosis of being HOW COMMON IS METABOLIC SYNDROME? overweight or obese must be coded from the provider’s Metabolic syndrome is quite common. Approximately documentation.3 20% - 30% of the population in the industrialized world have metabolic syndrome. By the year 2010, the metabolic syndrome is expected to affect 50 - 75 million people in the US Documentation and Coding Tips alone. 277.7 Dysmetabolic syndrome X 4 WHAT IS METABOLIC SYNDROME? Use additional code(s) for associated manifestation(s), such Metabolic syndrome (also known as syndrome X or as: dysmetabolic syndrome) was coined to designate a cluster 414.00 - 414.07 Cardiovascular disease of metabolic risk factors that come together in an individual 278.00 Obesity, unspecified (BMI 30-39.9) 278.01 Morbid obesity (BMI 40 or greater) who has cardiovascular risk factors. The main features of 278.02 Overweight (BMI 25-29.9) metabolic syndrome include: insulin resistance, hypertension, 278.03 Obesity hypoventilation syndrome cholesterol abnormalities and an increased risk for clotting. Coding Example: Patients are most often overweight or obese. While obesity A patient is seen in the endocrinologist’s office and diagnosed itself is likely the greatest risk factor, others factors of concern with Dysmetabolic Syndrome X and obesity.5 include: women who are post-menopausal, smoking, eating 277.7 Dysmetabolic syndrome X an excessively high carbohydrate diet, lack of activity (even 278.00 Obesity, unspecified without weight change) and consuming an alcohol-free diet. Obesity Reporting4: Use additional code to identify Body Mass Index (BMI), if HOW IS METABOLIC SYNDROME DEFINED? known: Based on the guidelines from the 2001 National Cholesterol • V85.21 - BMI 25.0-25.9 • V85.33 - BMI 33.0-33.9 2 Education Program Adult Treatment Panel (ATP III) any three of • V85.22 - BMI 26.0-26.9 • V85.34 - BMI 34.0-34.9 the following traits in the same individual meet the criteria for • V85.23 - BMI 27.0-27.9 • V85.35 - BMI 35.0-35.9 the metabolic syndrome: • V85.24 - BMI 28.0-28.9 • V85.36 - BMI 36.0-36.9 • Abdominal obesity: a waist circumference over 102 cm • V85.25 - BMI 29.0-29.9 • V85.37 - BMI 37.0-37.9 (40 in) in men and over 88 cm (35 inches) in women • V85.30 - BMI 30.0-30.9 • V85.38 - BMI 38.0-38.9 • V85.31 - BMI 31.0-31.9 • V85.39 - BMI 39.0-39.9 • Serum triglycerides 150 mg/dl or above • V85.32 - BMI 32.0-32.9 • HDL cholesterol 40mg/dl or lower in men and 50mg/dl For members with a BMI of 40 and over: or lower in women • Blood pressure of 130/85 or more • V85.41 - BMI 40.0-44.9, adult • Fasting blood glucose of 110 mg/dl or above. (Some • V85.42 - BMI 45.0-49.9, adult • V85.43 - BMI 50.0-59.9, adult groups say 100mg/dl) • V85.44 - BMI 60.0-69.9, adult Various strategies have been proposed to prevent the • V85.44 - BMI 70 and over, adult development of metabolic syndrome. These include increased physical activity (such as walking 30 minutes every day) and • Obesity due to a specified cause, such as thyroid disorder 3 a healthy, reduced-calorie diet. Compliance has been a major (240-246), is coded to the underlying condition. barrier to prevention. The information presented herein is for informational purposes only. It is not intended, nor is it to be 1 Ford ES, Giles WH, Dietz WH (2002). Prevalence of metabolic syndrome among US adults: used, to define a standard of care or otherwise substitute for informed medical evaluation, diagnosis and findings from the third National Health and Nutrition Examination Survey. JAMA 287(3):356- treatment which can only be performed by a qualified medical professional. Ingenix, Inc. does not warrant 359. PMID 11790215 or represent that the information contained herein is accurate or free from defects. 2 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. This information is for informational purposes only and does not replace the professional judgment and Executive Summary of The Third Report of The National Cholesterol Education Program expertise of the individual performing coding based on numerous factors including, but not limited to, (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In documentation in the medical record and other industry recognized coding guidance. Because codes, Adults (Adult Treatment Panel III). JAMA 2001;285:2486-97. PMID 11368702 coding requirements and standards can and do change, the individual assigning codes is reminded to 3 Brown, Faye. Faye Brown’s ICD-9-CM Coding Handbook with Answers, 2011. Chicago: AHA verify the accuracy, specificity, currency and acceptability of such codes and coding methods used. Press, 2010.Print. 4 World Health Organization, Professional: ICD-9-CM for Physicians—Volumes 1 & 2. 2011. For more information on Ingenix and the products and services we offer, contact us at www.ingenix.com Alexandria, VA: Ingenix, 2010, October. Print. or call (800) 765-6713. If you have questions or wish to be removed from this fax, please contact your local 5 AHA Coding Clinic 4th Q, Dysmetabolic Syndrome X, 2001 Ingenix Market Consultant. © Ingenix 2010 IN064