A new subset of obesity diagnosis codes was added to the ICD-10-CM Official Guidelines for Coding and Reporting in October with the creation of subcategory E66.81, Obesity class.
This subcategory has new codes that identify different classes of obesity in adults based on body mass index (BMI):
Obesity and morbid obesity are chronic complex diseases in adults and children that can intensify the risk of heart disease; diabetes mellitus type 2; hypertension; high cholesterol; breathing issues such as asthma and sleep apnea; problems with reproduction; joint disease and certain cancers. They are serious medical conditions that are clinically significant for coding.
Although the new obesity class codes are defined by BMI, coders are not able to assign a diagnosis code for obesity unless the condition has been documented by the provider in the medical record, as established in the ICD-10-CM Official Guidelines for Coding and Reporting, Section I.B.14:
Code assignment is based on the documentation by the patient's provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient's diagnosis). There are a few exceptions when code assignment may be based on medical record documentation from clinicians who are not the patient’s provider (i.e., physician or other qualified healthcare practitioner legally accountable for establishing the patient’s diagnosis). . . . This information is typically, or may be, documented by other clinicians involved in the care of the patient (e.g., a dietitian often documents the BMI, a nurse often documents the pressure ulcer stages, and an emergency medical technician often documents the coma scale). However, the associated diagnosis (such as overweight, obesity, acute stroke, pressure ulcer, or a condition classifiable to category F10, Alcohol related disorders) must be documented by the patient’s provider.
If the patient has a significant BMI, please evaluate whether they may have a diagnosis of obesity and document your findings in the encounter. The obesity class codes do not replace the previous classification of obesity versus morbid obesity — so, continue to document morbid obesity when clinically appropriate.
Coders strive to capture as complete and accurate a clinical picture as possible, and we rely on provider documentation to capture a patient’s true medical condition.
The complete ICD-10-CM Guidelines can be found here.
Reference: Coding Clinic Volume 11, Number 4, Fourth Quarter 2024, page 8.