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BMI, BP Screening and Morbid Obesity

Body mass index and blood pressure screenings are two simple but effective tools to minimize risk factors that can lead to many chronic diseases and conditions such as obesity, hypertension, hyperlipidemia, cardiovascular disease, diabetes, osteoarthritis, certain types of cancer, sleep apnea, and more.

Ranges and thresholds do not meet the criteria for this measure. A distinct BMI value or percentile is required to satisfy the measure. Remember to include the correct patient name, DOB, date of service, and the servicing provider’s full name, signature, and credentials on each progress note.

Download the full Body Mass Index (BMI) and Blood Pressure Screenings article for examples of BMI and blood pressure codes.

Medicare Risk Adjustment Coding for Morbid Obesity

Morbid obesity is a common condition and is often overlooked in coding – particularly as it pertains to risk adjustment. Morbid obesity is clinically significant as it puts the patient at an increased risk for certain other medical conditions or complications. Both morbid obesity and a BMI >40 are HCCs in the Medicare Risk Adjustment Model. 

For adults, the specific BMI value must be documented, not a range. A coder is not permitted to calculate the BMI based on weight and height. As per ICD-10 CM guidelines, BMI codes should only be assigned when the associated diagnosis (such as overweight or obesity) meets the definition of a reportable diagnosis. A BMI code should only be reported as a secondary diagnosis. The codes for obesity vary in ICD-10 and must be explicitly documented by the treating provider in the medical record. A coder can never assume “morbid obesity” based on a BMI >40.

Best Practices

  • Outreach to patients to schedule yearly and follow-up on appointments. Advise patients to avoid caffeine prior to the visit.
  • Remind patients with hypertension about the importance of taking their medication, and its effect on blood pressure readings. Document those patients not taking medication as prescribed.
    Note: If blood pressure reading is high when the patient arrives, re-check later in the visit before the patient leaves the office.
  • Review diet (e.g. eat healthy, avoid alcohol consumption, reduce sodium intake, etc.), medications, exercise regimen, and treatment adherence with the patient at each visit. Consider prescribing a blood pressure monitoring device for members with uncontrolled HTN.
  • Help patients set self-management goals, which may include quitting smoking, home blood pressure monitoring, stress reduction, exercise, meditation, and losing weight

HealthCare Partners (HCP) is here to help!

HCP Pharmacy Staff
Call: (516) 515–8861
Monday through Friday, 8:30am – 5:30pm EST

HCP Case Managers
Call: (888) 258–0203
Monday through Friday, 8:30 am – 5:30 pm EST
Our Case Managers can:

  • Teach patients about their condition.
  • Guide them in making a treatment plan.
  • Help them get medications and care.
  • Coordinate transportation based on member’s assigned benefit.
  • Set up referrals and doctor visits.
  • Provide a Nurse on call, 24/7 at (516) 238-6124.

Updated April, 2024