How to select the correct obesity codes

Q: One of our physicians is getting conflicting information regarding the ICD-10 codes E66.01 and E66.9. We have been coding E66.9 for Body Mass Indexes (BMIs) between 30-34 and E66.01 for BMIs>35.

She has a laminated cheat sheet that says E66.9 if for BMIs 30-39 and E66.01 is for BMIs>40. Can you clarify when to use each of these codes?

A: The E codes E66.01 and E66.9 are used to describe various types of obesity, in words.

E66.01 is morbid (severe) obesity from excess calories. E66.9 is unspecified obesity.

A range of BMIs can be assigned to various categories of obesity:

This table would give you E66.01 for BMIs over 40. To report specific BMIs in addition to the E codes use code Z68.xx. These are for adults. Z68.30 is 30.0 to 30.9 BMI. Z68.31 is 31.0 - 31.9 BMI etc. So the E codes loosely map to specific BMIs.

It’s likely you should not be using E66.9. You’d only use this if you didn’t know the BMI or the reason for it. If you know what the BMI is you should be able to assign it to either E66.01, E66.3 (overweight) or E66.8 (other obesity).

Q: When do I use ICD-10 codes Z00.121 instead of Z00.129?

A: You use a Z00.129 (Child well without abnormal findings) when you aren’t either dealing with or reporting any other problems along with the well visit. The Z00.121 codes are used to report a well-child visit with abnormal findings. These can be either diagnoses or signs and symptoms encountered during the visit, or other issues addressed during the encounter such as pre-existing problems or complaints. Regardless of how other issues arise - you report the additional specific diagnosis codes with the Z00.121.

If you are doing the “well” visit and are also addressing those other issues (and have some HPI and A/P for those issues) - then that is when you bill both the wellness CPT code and the sick visit CPT code (i.e.99393, 99213-25) and the two types of ICD-10 codes, Z00.121 and H66.41 (OM right ear for example).

Q: What is the procedure code for instilling fluorescein into the eye to check for corneal abrasions with the Wood’s lamp?

A: The fluorescein stain application alone is not a billable code. The billable version of this is a corneal foreign body removal with or without the lamp.

In many cases the application and exam is billed as part of an E/M visit. The code 92230 was changed some years ago and can no longer be billed for this service.

If you do remove a corneal foreign body as a result of this, you would bill either 65220 or 65222 for the without or with lamp respectively. Theoretically you could bill either of these two codes without actually removing a foreign body, and append a modifier -52 for reduced services - but this would quite likely not be paid and would certainly require that documentation be sent with the claim.