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Q&A: Coding BMI from a dietician's note

CDI Strategies, February 21, 2008

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Q: Can a coder code body mass index (BMI) from a dietician's note? As a clinical documentation improvement (CDI) specialist, I'm not sure whether I am required to ask the physician to document the patient's BMI if a dietician has already documented it.

A: Yes, coders can assign a BMI (code V85.xx) using a dietician's documentation. However a coder may not assign a diagnosis code for obesity (278.xx) using documentation from anyone other than a physician or other approved practitioner. You can find this reference in Coding Clinic, Fourth Quarter 2005, pp. 96-98.

Although this Coding Clinic reference does not specifically reference the diagnosis of underweight (code 783.22), I would presume the guidance for this diagnosis is the same. This is the only reference I am aware of which states that coders can assign codes based on a non-physician/practitioner's documentation.

This may have implications with the new Medicare-Severity DRGs, because extreme BMI's (less than 19 or 40 and above) are considered to be a complication/comorbidity (CC) this year. It is interesting that underweight and obesity are not considered CCs, but their respective BMIs are.

Remember that BMIs only identify the ratio of height to weight. Many factors can alter a BMI (e.g., muscular people, lactating women, or pregnant women), so it is not appropriate to assume that someone is obese from a high BMI nor underweight from a low BMI.

You can find the formula to determine BMI at the American Obesity Association Web site (www.obesity.org/education/advisor.shtml).

Lastly, it is not appropriate for coders to calculate BMIs even when a physician documents the patient's height and weight.

(Shannon McCall, RHIA, CCS, CPC, director of HIM and coding for HCPro, Inc., in Marblehead, MA, answered this question.)

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