Closing Gaps & Meeting Metrics Quality Revenue Program Management Newsletter

March 2019 Morbid Obesity, and Cachexia

Morbid Obesity It’s National Nutrition Month!

According to the National Institutes of Health, obesity Our focus during National Nutrition Month is to has emerged as a leading public health concern in present current coding and documentation guidance the United States. People who are obese face in- on some nutrition related conditions that may be creased risks of death from heart , stroke and prevalent in provider offices and clinical settings. certain . The Centers for Disease Control National Nutrition Month is a nutrition education and defines obesity as ”weight that is higher than what is information campaign from the Academy of Nutrition considered as a healthy weight for a given height.” and Dietetics. Held annually in March, it focuses (BMI), an obesity screening tool, attention on the importance of making informed food subdivides obesity into severity or categories:

Class BMI Range Class 3 obesity (with BMI Malnutrition 1 30 To < 35 of 40 or higher) is some- 2 35 to < 40 times categorized as Malnutrition occurs when the body doesn't get 3 40 or higher extreme, severe or morbid. enough nutrients. Causes include a poor diet, diges- tive conditions, or another disease. Document all For correct coding, documentation should include: clinical used to make a malnu- trition diagnosis such as:  Severity: overweight, obese, or morbidly obese  BMI < 19%  Contributing factors: excessive calories or drug induced  Low body weight: < 80% ideal weight  Association: pregnancy  Significant from baseline  2% decrease in 1 month  Symptoms/findings/manifestations: BMI or  5% decrease in 3 months alveolar hypoventilation  10% decrease in 6 months

Coding  Calf circumference of less than 31 cm  E66.01: Morbid (severe) obesity due to excess Note that low albumin and pre-albumin states are no calories longer considered diagnostic since these lab results are affected by inflammation.  E66.2: Morbid (severe) obesity with alveolar hypoventilation (continued on page two)

ICD-10-CM instructional notes tell us to use an addi- tional code to identify the BMI if known.

If the BMI is not greater than 40, you can still assign the E66.01 code when one or more of the following is met:  100 pounds or more above the ideal body weight  BMI of 40 or greater  BMI of 35 or greater and one or more comorbidity Quality Revenue Program Management

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Obesity, Malnutrition and Cachexia

Malnutrition (continued from page one) Frequently Used Malnutrition Cachexia ICD-10-CM Codes ICD-10-CM Codes Cachexia codes to R64. ICD-10-CM manual instruc- Diagnosis/Documentation/Terms Code tional notes advise to first code the underlying con- dition, if known. Notes for Type 1 Excludes tell us Kw ashiorkor E40 (due to malnutrition) – unspecified that if the following diagnoses are documented, the E41 (codes to nutritional maras mus) R64 code does not apply: Malnutrition – Severe pro-cal intermediate form  abnormal weight loss (R63.4) (codes to maras mic kw ashiorkor) E42  nutritional (E41) Maras mic kw ashiorkor Malnutrition – severe protein-calorie / protein-energy E43 Supportive documentation for both malnutrition and edema cachexia should include findings such as the follow- Malnutrition – moderate protein-calorie E44.0 Malnutrition – moderate protein-energy ing list (not all inclusive): Malnutrition – mild protein-calorie  Clinical manifestations of asthenia; ; ear- E44.1 Malnutrition – mild protein-energy ly satiety; nausea; taste change; and significant Malnutrition – unspecified loss of body fat, muscle and other components Malnutrition – protein-calorie, unspecified E46 Protein-calorie or protein-energy Imbalance  The patient may be normothermic, febrile or hy- Weight loss R63.4 pothermic. The skin is atrophic, shiny or flaky Underw eight w ith BMI 19 or less R63.8 and has loose folds. (child) R62.51  The temporal fossae are sunken as are the Failure to thrive (adult) R62.7 cheeks, leaving prominent zygomatic protuber- ances. Cachexia  The eyes may appear to bulge. Cachexia, also known as a syndrome, is  Old denture plates become too large because of loss of weight, muscle , , gum atrophy. and significant loss of in someone who is  The anatomy of the fat-depleted neck is revealed not actively trying to lose weight. Cachexia includes with prominent borders of the sternocleidomas- as a part of its pathology. toid muscles, larynx, and clavicles. cachexia or malignant cachexia is a wasting syndrome characterized by weight loss, anorexia, asthenia and anemia. The signs and symptoms of cachexia are considered as the prognostic parame- ters in cancer patients and should be included in the medical record documentation This can include the following:  Involuntary weight loss of greater then 10% of baseline body weight  Atrophy of muscles and depletion of lean body mass  Wasting or signs of malnutrition as a result of inadequate dietary intake, or hypermetabolism

References  eatrightpro.org/media/multimedia-news-center/  journal.ahima.org/2018/06/12/parsing-overweight- national-nutrition-month-media-materials and-obesity-coding Elena Miller, MPH, RHIA,  cdc.gov/obesity/adult/defining.html CCS/  icd10monitor.com/hungry-for-accuracy-on-  coder.aapc.com/icd-10-codes-range/62 malnutrition Quality Revenue Program Management

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