After taking my CRC and course, I was told that per CMS morbidly obese was considered to be 40 or greater. I have a provider that is questioning me about this. Can I get a good resource regarding the accuracy of this? Thank you.
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What Is Considered Morbidly Obese per CMS?
- Thread starter NatashaP_63838
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Lori
Well-known member
According to the CDC, extreme obesity or class 3 obesity usually indicates a body mass index (BMI) of 40 or greater. Obesity class 2 indicates moderate-risk obesity, with a BMI ranging from 35.0 to 39.9. Obesity class 1 is low-risk obesity, with a BMI of 30.0 to 34.9
www.aapc.com
BMI Chart
https://pro.aace.com/files/obesity/toolkit/bmi_table.pdf
More on Obesity:
Effective for claims with dates of service on or after November 29, 2011, Medicare beneficiaries with obesity (BMI ≥30 kg/m2)
www.cms.gov
A BMI less than 35 are not reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act
In 2006, CMS established a National Coverage Determination (NCD) on Bariatric Surgery for the Treatment of Morbid Obesity (NCD Manual Section 100.1).For Medicare beneficiaries who have a BMI ≥ 35, have at least one co-morbidity related to obesity, and who have been previously unsuccessful with medical treatment for obesity, the following procedures were determined to be reasonable and necessary: •open and laparoscopic Roux-en-Y gastric bypass (RYGBP); •laparoscopic adjustable gastric banding (LAGB); and, •open and laparoscopic biliopanc
Let’s Get on the Same Page when Coding BMI and Obesity
Different interpretations of ICD-10-CM coding leave you at risk for improper quality scores and payment. Medical record auditors see a wide range of Auditors see a wide range of interpretation regarding when and how overweight, obesity, and morbid obesity diagnoses should be abstracted from...
BMI Chart
https://pro.aace.com/files/obesity/toolkit/bmi_table.pdf
More on Obesity:
Effective for claims with dates of service on or after November 29, 2011, Medicare beneficiaries with obesity (BMI ≥30 kg/m2)
MCD Search
The Redesigned MCD Search Page lets you search on a keyword, code, or document ID
A BMI less than 35 are not reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act
In 2006, CMS established a National Coverage Determination (NCD) on Bariatric Surgery for the Treatment of Morbid Obesity (NCD Manual Section 100.1).For Medicare beneficiaries who have a BMI ≥ 35, have at least one co-morbidity related to obesity, and who have been previously unsuccessful with medical treatment for obesity, the following procedures were determined to be reasonable and necessary: •open and laparoscopic Roux-en-Y gastric bypass (RYGBP); •laparoscopic adjustable gastric banding (LAGB); and, •open and laparoscopic biliopanc
Thank you all so much.According to the CDC, extreme obesity or class 3 obesity usually indicates a body mass index (BMI) of 40 or greater. Obesity class 2 indicates moderate-risk obesity, with a BMI ranging from 35.0 to 39.9. Obesity class 1 is low-risk obesity, with a BMI of 30.0 to 34.9
Let’s Get on the Same Page when Coding BMI and Obesity
Different interpretations of ICD-10-CM coding leave you at risk for improper quality scores and payment. Medical record auditors see a wide range of Auditors see a wide range of interpretation regarding when and how overweight, obesity, and morbid obesity diagnoses should be abstracted from...
BMI Chart
https://pro.aace.com/files/obesity/toolkit/bmi_table.pdf
More on Obesity:
Effective for claims with dates of service on or after November 29, 2011, Medicare beneficiaries with obesity (BMI ≥30 kg/m2)
MCD Search
The Redesigned MCD Search Page lets you search on a keyword, code, or document ID
A BMI less than 35 are not reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act
In 2006, CMS established a National Coverage Determination (NCD) on Bariatric Surgery for the Treatment of Morbid Obesity (NCD Manual Section 100.1).For Medicare beneficiaries who have a BMI ≥ 35, have at least one co-morbidity related to obesity, and who have been previously unsuccessful with medical treatment for obesity, the following procedures were determined to be reasonable and necessary: •open and laparoscopic Roux-en-Y gastric bypass (RYGBP); •laparoscopic adjustable gastric banding (LAGB); and, •open and laparoscopic biliopanc
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