Coding Obesity--What are your thoughts on this??
This is a response to the nurse coding the patient with obesity. "The POC is complete and we will NOT be reopening it OR calling the MD for verification on the obesity. It will be just fine as we can calculate the BMI based on the Oasis height and weight. Use the BMI calculator on the internet! This patient's obesity will affect/impact her POC, and that is what we are concerned with and that is why we are using it. The PT assessment and clinical assessment by me (case manager) makes it NOT necessary to call the physician to ask them if the patient is Obese, it is Evident that she is. Once the MD signs the POC we will have the signed documentation to support all our diagnosis codes. I can assure you the MD will be happy to sign her 485/POC with obesity on it, because she IS in fact Obese! Based on Oasis conventions and based and the CLINICAL assessment it will be left, it is within the guidelines (legal) to code this way. Besides it is just a supporting diagnosis that is not a payor code.
Comments
Andrea Michelle Smith, BSN, RN, COS-C, BCHH-C
First, it sounds like this clinician has either had a very bad day or they
need some intervention by the appropriate supervisor for this poor attitude
and response to you trying to do your job. I would definitely let him/her
know that it is not acceptable to communicate with you in this manner and
that an apology is owed.
Second, from my 2017 Decision Health manual: "When assigning a code for
any overweight, obesity, or morbid obesity, physician documentation
indicating obesity as a diagnosis is required. If suspected, but not
present, the coder may query the provider to obtain confirmation of the
condition, but may not code obesity without confirmation from the
provider. BMI may be calculated and coded based upon nursing documentation
alone and calculated BMI may be coded alone without a diagnosis of
obesity. The coder can use the Z68 codes for BMI based on calculations by
other clinicians." So your clinician is incorrect in his/her assertion
that you can enter an obesity code without the Dx coming from the MD.
Another apology owed!
I'm sorry you have to put up with this type of personality and hope you
don't run into this clinician too often!
Regards,
Karla
*Karla Gambrill PT, DPTClinical Coordinator of Therapy ServicesHMC Home
Health(908) 788-6672*
they are refusing to speak to that clinician, they are condoning this
terrible culture in the agency. Are you contracted with this company or an
employee? If employed, it may be time to look for another position.
Please don't let yourself be treated like this (especially since you're in
the right!). You deserve to be heard and respected for your area of
expertise - even if you don't have "RN" after your name. I've received
similar feedback at times (along the lines of "the clinician says it x so
that's what you should code") and I just have to refuse to be bullied. I
use email so that everything is written down and say something like "just
to clarify: the coding guidelines state xyz and you are directing me to
code abc instead?" I'll happily code whatever they want, as long as I have
that documentation that I'm following the regulations.
*Karla Gambrill PT, DPTClinical Coordinator of Therapy ServicesHMC Home
Health(908) 788-6672*