Coding for Obesity

In This Section

Obesity is defined as having a body mass index (BMI) of 30 or higher.¹ From 2017 through 2020, the prevalence of obesity in the United States was 41.9%.² Many patients have questions regarding weight during their visits with their obstetric-gynecologic health care professionals. As a companion to the Compassionate Conversations webinar on having sensitive, thoughtful conversations around obesity, this coding resource can help practices seek reimbursement for these services and provide quality patient care.

Patients see their obstetrician-gynecologist and other specialty health care professionals for a variety of reasons, including for regular health screenings and pregnancy. While this resource will focus on coding for Evaluation and Management (E/M) services as well as coding for obesity during pregnancy, there are other requirements and methods for coding for obesity in various circumstances. These nuances can be explored in the current version of the ACOG Coding Manual.

Evaluation and Management (E/M) Level for Billing for Obesity

Obesity is a chronic condition that can justify the billing of a problem E/M level of service (99202-99215). However, the appropriate level of services will depend on the specific circumstances related to the patient’s condition and the provider’s documentation on how the complication influenced the management of the patient’s condition.

New Patient Visits

CPT Code	Code Description	Medical Decision Making	Total Time
99202	Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 15–29 minutes of total time is spent on the date of the encounter.	Straightforward	15–29
99203	Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 30–44 minutes of total time is spent on the date of the encounter.	Low	30–44
99204	Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 45–59 minutes of total time is spent on the date of the encounter.	Moderate	45–59
99205	Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 60–74 minutes of total time is spent on the date of the encounter. (For services 75 minutes or longer, see Prolonged Services 99XXX)	High	60–74

Established Patient Visits

CPT Code	Code Description	Medical Decision Making	Total Time
99211	Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal.	N/A	N/A
99212	Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using time for code selection, 10–19 minutes of total time is spent on the date of the encounter.	Straightforward	10–19
99213	Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20–29 minutes of total time is spent on the date of the encounter.	Low	20–29
99214	Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30–39 minutes of total time is spent on the date of the encounter.	Moderate	30–39
99215	Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using time for code selection, 40–54 minutes of total time is spent on the date of the encounter. (For services 55 minutes or longer, see Prolonged Services 99XXX)	High	40–54

Coding for Obesity in Pregnancy

A patient is usually seen for 13 visits, but extra visits might occur if the patient is seen due to a complication or medical problems that affect the pregnancy. If the "high-risk" patient is seen more than the usual 13 visits, but no complications develop in the current pregnancy, then ONLY the global service would be reported.

However, if the number of visits exceeds 13 because of complications, then the additional visits are reported using E/M codes, but they are not reported to the payer until patient delivers.

Note: Most payers will not pay for a pregnancy-related E/M service that occurs at the same encounters with a scheduled antepartum visit.

The reasons are:

The global obstetric payment already includes reimbursement for 13 visits, even if the 13 visits do not really occur. Their case is that waiting to bill the total visits at the end of the pregnancy will help to determine whether the work or services provided regarding the complication ultimately represents more than the typical work (13 visits) for which the provider will be paid.
There is no way to accurately value the additional E/M service taking place at the time of a routine visit because the dividing line between the routine service and the additional service can’t be definitively identified.

Possible Diagnosis Code for Reporting Obesity in Pregnancy

O99.21 – Obesity complicating pregnancy, childbirth, and puerperium
- O99.210 – Obesity complicating pregnancy, unspecified trimester
- O99.211 – Obesity complicating pregnancy, first trimester
- O99.212 – Obesity complicating pregnancy, second trimester
- O99.213 – Obesity complicating pregnancy, third trimester
- O99.214 – Obesity complicating childbirth
- O99.215 – Obesity complicating puerperium

Note: These codes have a sequencing priority over other codes and must be listed first as the primary diagnosis. Furthermore, the ICD-10-CM guidelines prohibit assigning BMI codes for obese and overweight patients who are pregnant.

References

Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser 2000;894:1–253.
Centers for Disease Control and Prevention (CDC). National Center for Health Statistics (NCHS). National Health and Nutrition Examination Survey Data. Hyattsville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2021.