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CHAPTER 33

Pediatric Obesity

Julie LaMothe

I.  INTRODUCTION

A.  Obesity (BMI above the 95th percentile) is increasing among children and adolescents. Pediatric obesity has tripled since 1980. A majority of obese children remain obese as adults. The risk of pediatric obesity is related to childhood diet and sedentary time. Obesity is associated with higher blood pressure, elevated blood lipids, insulin resistance, impaired glucose tolerance, and increased risk of several chronic diseases of adulthood, including diabetes, hypertension, dyslipidemia, sleep apnea, cardiovascular disease (CVD), fatty liver, metabolic syndrome, hepatic stenosis, orthopedic complications, pseudotumor cerebri, and some cancers. In addition, obesity in childhood can have psychosocial implications including low self-esteem, impaired quality of life, and depression.

II.  CODING FOR OBESITY

A.  Many insurance carriers will deny claims submitted with obesity codes. The following is a guide to coding for obesity-related healthcare services: “Obesity and Related Comorbidites Coding Fact Sheet for Primary Care Pediatricians,” from the NICQUE Academy of Pediatrics.

B.  Additional resources include:

1.  
Pediatric Coding Companion
, from the NICHQ Academy of Pediatrics.

2.  
Coding and reimbursement for children with abnormal weight gain in primary care
, from the NICHQ Academy of Pediatrics.

3.  
Denials (Strategies and a Template letter for pediatric practices)
, from the AAP Member Center.

4.  
AAP Hassle Factor Form
, from the AAP Member Center.

C.  Codes for procedures.

1.  Calorimetry, 94690.

2.  Glucose monitoring, 95250.

3.  Venipuncture, 36415.

D.  Healthcare Common Procedure Coding System (HCPCS) education and counseling codes.

1.  S9445, patient education individual.

2.  S9446, patient education group.

3.  S9449, weight management class.

4.  S9451, exercise class.

5.  S9452, nutrition class.

6.  S9454, stress management class.

7.  S9470, nutrition counseling.

E.  Common diagnosis codes, ICD-9-CM codes.

1.  Circulatory system.

a.  401.9, hypertension.

b.  429.3, cardiomegaly.

2.  Congenital anomalies.

a.  758.0, Down syndrome.

b.  759.81, Prader-Willi syndrome.

c.  759.89, other specified anomalies.

3.  Digestive system.

a.  530.81, esophageal reflux.

b.  564.00, constipation.

c.  783.3, feeding difficulties and mismanagement.

d.  571.8, other chronic nonalcoholic liver disease.

e.  789.1, hepatomegaly.

4.  Endocrine, nutritional, metabolic.

a.  244.8, other specified acquired hypothyroidism.

b.  244.9, unspecified hypothyroidism.

c.  250, diabetes mellitus, type 2 or unspecified type, uncontrolled.

d.  253.8, other disorders of the pituitary.

e.  255.8, other disorders of the adrenal glands.

f.  256.4, polycystic ovaries.

g.  259.1, precocious sexual development and puberty.

h.  259.9, unspecified endocrine disorder.

i.  272, pure hypercholesterolemia.

j.  272.1, pure hyperglyceridemia.

k.  272.2, mixed hyperlipidemia.

l.  272.4, other and unspecified hyperlipidemia.

m.  272.9, unspecified disorder of lipoid metabolism.

n.  277.7, dysmetabolic syndrome X/metabolic syndrome.

o.  278, obesity, unspecified.

p.  278.01, morbid obesity.

q.  278.02, overweight.

r.  278.1, localized adiposity.

s.  783.1, abnormal weight gain.

t.  783.4, lack of normal physiological development.

u.  783.43, short stature.

v.  783.5, polydipsia.

w.  783.6, polyphagia.

5.  Genitourinary system.

a.  611.1, hypertrophy of the breast.

6.  Mental disorders.

a.  300, anxiety state, unspecified.

b.  300.02, generalized anxiety disorder.

c.  307.5, eating disorder, unspecified.

d.  307.51, bulimia nervosa.

e.  307.59, other and unspecified disorders of eating.

f.  311, depressive disorders.

g.  313.81, oppositional defiant disorder.

7.  Nervous system.

a.  732.4, obstructive sleep apnea.

b.  327.26, sleep-related hypoventilation/hypoxemia in conditions classifiable elsewhere.

c.  780.51, insomnia with sleep apnea.