Cracking the Code

Coding Obesity

According to the World Health Organization, “overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. The issue has grown to epidemic proportions, with over 4 million people dying each year because of being overweight or obese in 2017 according to the global burden of disease.”


Obesity is a complex disease involving having too much body fat. Obesity isn’t just a cosmetic concern. It’s a medical problem that increases the risk of many other diseases and health problems. These can include heart disease, diabetes, high blood pressure, high cholesterol, liver disease, sleep apnea, and certain cancers.


In our ICD-10-CM codebooks, overweight and obesity are separated by coding. The coding for obesity includes the cause of the obesity such as obesity due to excess calories, drug-induced and with alveolar hypoventilation. Correct coding of obesity includes the cause and if the obesity is considered morbid. A secondary code for the BMI from category Z68- should also be used when the codes for underweight, overweight, or obesity are used.


Pay close attention to the ICD-10-CM guideline, I.C.21.C.3, for BMI (Body Mass Index), where it states, “BMI codes should only be assigned when there is an associated, reportable diagnosis (such as obesity). Do not assign BMI codes during pregnancy.”

Q: A 32-year-old male patient presents for consultation for bariatric surgery. The physician has documented that the patient was counseled on controlling his calories. The patient will be seeing a dietician to provide a meal plan for him to lose some weight. The patient states he eats more than 3,000 calories a day and does not exercise. His weight is 290 pounds, and his BMI is documented at 37. The physician documents morbid obesity due to overeating. What is(are) the ICD-10-CM diagnosis codes for this encounter?
A: E66.01, Z68.37 Rationale: In this example, the patient is diagnosed with morbid obesity. In the ICD-10-CM Alphabetic Index, we will search for Obesity/morbid/due to excess calories which directs us to E66.01. This subcategory has an instructional note to use an additional code for the BMI. Next, let’s look at the Alphabetic Index for Body, bodies/mass index [BMI]/37.0-37.9 which directs us to Z68.37. As always, we want to verify the code selection in the Tabular List.
Reference: FY 2023 ICD-10-CM code book & guidelines
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