This a heads-up on a definitional change coming our way. There will be the launching of a new framework for obesity in mid-January, per a commission of academic clinicians, scientists, public health experts, patient representatives, and the World Health Organization (WHO).
The consensus statement will be published in The Lancet Diabetes and Endocrinology, and more than 75 medical societies and other organizations have endorsed it.
The concept is that individuals who have excess adiposity, or fat, in their body can either be at risk of or be actively experiencing adverse effects and bodily harm from it. The state of having excess adiposity with consequent tissue and organ abnormalities is being reframed as a disease state called “clinical obesity.”
Currently, we assess a patient’s body mass index (BMI) to diagnose obesity. BMI has limitations. The formula used to calculate BMI uses a patient’s weight, but there is no consideration for whether the weight is due to lean body mass or fat mass. A very muscular person may have a high BMI, but low fat mass. BMI doesn’t note where fat has accumulated. Central abdominal fat due to visceral fat offers a higher risk of conditions like heart disease and diabetes.
BMI is useful as a screening tool, but once obesity has been identified, whether it is clinical or nonclinical needs to be established. This is even embedded in how we currently stratify obesity. The condition that used to be called “morbid obesity” has been rebranded as Class 3 obesity, or severe obesity. It is characterized by a BMI ≥ 40 or a BMI ≥ 35 with obesity-related health conditions. Examples of these conditions are hypertension, Type 2 diabetes, and atherosclerotic heart disease.
Just like the evolution of sepsis caused all sorts of coding headaches, I predict that the change in obesity nomenclature may cause coding troubles in ICD-10-CM. The current indexing has a code, E66.2, for morbid obesity with alveolar hypoventilation, also known as obesity hypoventilation syndrome. E66.2 is the only comorbid condition or complication (CC) in the subcategory. There is also a code for morbid obesity due to excess calories, E66.01, but I wonder how often clinicians use this precise verbiage. Fortunately, the indexing of the phrase “morbid obesity” allows assignment of E66.01. On Oct. 1, 2024, the code set expanded to include the classes of obesity (Classes 1-3). Class 3 obesity is coded with E66.813. If a provider says, “Morbid obesity, Class 3,” how is that handled?
Is the verbiage, “clinical obesity” going to be assigned E66.89, Other obesity not elsewhere classified, or E66.9, Obesity, unspecified? Are providers going to diagnose specific classes of obesity as clinical obesity, if there are obesity-related conditions?
Coders are permitted to pick up the Z code indicating the BMI if a practitioner has made a nutritional diagnosis, even if the BMI has been recorded by a nurse or dietitian. If the clinician only explicitly diagnoses “obesity,” but the BMI is 42, should the clinical documentation integrity (CDI) specialist or coder pick up the obesity without the more specific classification? BMI of 40 or greater also affords the Complication or Comorbidity (CC) designation.
For Diagnosis-Related Group (DRG) and reimbursement purposes, the unspecified code for obesity with the BMI of ≥ 40 to 44.9 giving the CC of Z68.41 would be adequate. Codes are not only for reimbursement, but also for epidemiological, statistical, and public policy purposes.
Now that we have some very effective treatments in the glucagon-like peptide-1 receptor agonist drugs, we want to be sure that patients at highest risk get preferential access. But are we really going to query for higher specificity?
It will be interesting to see if WHO is going to adapt ICD-11, according to this new disease definition, since they were at the table creating the framework.
Whether it will trickle down and over to ICD-10-CM is yet to be seen.
Programming note:
Listen to Dr. Erica Remer as she cohosts Talk Ten Tuesday today with Chuck Buck at 10 am Eastern.
Today is Mardi Gras, which is French for “Fat Tuesday.” It is the last day before lent starts tomorrow, Ash Wednesday. This got me thinking
EDITOR’S NOTE: The narrative in this article reflects the firsthand perspectives and professional experience of Tami McMasters Gomez, curated and prepared for publication by Penny
Please log in to your account to comment on this article.
Sepsis sequencing continues to challenge even experienced coding and CDI professionals, with evolving guidelines, documentation gaps, and payer scrutiny driving denials and data inconsistencies. In this webcast, Payal Sinha, MBA, RHIA, CCDS, CDIP, CCS, CCS-P, CCDS-O, CRC, CRCR, provides clear guideline-based strategies to accurately code sepsis, severe sepsis, and septic shock, assign POA indicators, clarify the relationship between infection and organ dysfunction, and align documentation across teams. Attendees will gain practical tools to strengthen audit defensibility, improve first-pass accuracy, support appeal success, reduce denials, and ensure accurate quality reporting, empowering organizations to achieve consistent, compliant sepsis coding outcomes.
Expert presenters Kathy Pride, RHIT, CPC, CCS-P, CPMA, and Brandi Russell, RHIA, CCS, COC, CPMA, break down complex fracture care coding rules, walk through correct modifier application (-25, -57, 54, 55), and clarify sequencing for initial and subsequent encounters. Attendees will gain the practical knowledge needed to submit clean claims, ensure compliance, and stay one step ahead of payer audits in 2026.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
As AI reshapes healthcare compliance, the risk of biased outputs and opaque decision-making grows. This webcast, led by Frank Cohen, delivers a practical Four-Pillar Governance Framework—Transparency, Accountability, Fairness, and Explainability—to help you govern AI-driven claim auditing with confidence. Learn how to identify and mitigate bias, implement robust human oversight, and document defensible AI review processes that regulators and auditors will accept. Discover concrete remedies, from rotation protocols to uncertainty scoring, and actionable steps to evaluate vendors before contracts are signed. In a regulatory landscape that moves faster than ever, gain the tools to stay compliant, defend your processes, and reduce liability while maintaining operational effectiveness.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
