The Centers for Medicare and Medicaid Services and the National Center for Health Statistics provide guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). ICD-10-CM diagnosis codes are used to classify and diagnose disease processes, assess disease management, billing, and health services research. The ICD-10-CM diagnosis codes for childhood and adult obesitylack the specificity needed for categorizing elevated BMI in children, adolescents and adults. Furthermore, the current codes are stigmatizing and reflect outdated scientific understanding of the disease processes underlying obesity.
The STOP Obesity Alliance has worked for over two years with the Centers for Disease Control’s Division of Nutrition, Physical Activity, and Obesity to propose new ICD-10-CM codes for both the pediatric and adult diagnosis of obesity. In September 2023, the National Center for Health Statistics (NCHS) approved updated ICD-10-CM obesity codes and they go into effect on October 1, 2024.
Current child and adult obesity codes in ICD-10-CM are clinically imprecise because they do not capture the nature of the disease process according to our current scientific understanding. The codes suggest that the cause of obesity is simply an imbalance in caloric intake. This understanding is no longer accepted.
The current codes also do not allow for the necessary use of percentile-based BMI classification in children and adolescents. The classification of obesity clinically begins with overweight and progresses through severe obesity. Accurate classification is important because the risk of morbidity and mortality increases as excess weight increases.
Finally, the current obesity codes use terms such as “morbid” and “due to excess calories,” which are inaccurate and pejorative and may lead to stigmatization and blaming the patient. Stigmatization, in turn, is associated with reduced access to care and poorer health outcomes.
As shown in the figure below, the new E-codes for adult obesity are E66.811, E66.812, and E66.813. These codesshould be used together with the existing adult BMI Z-codes. The three new E-codes reflect obesity severity expressed in terms of body mass index (BMI) percentile.
For children and adolescents with obesity, providers should use the new E-codes: E66.811, E66.812, and E66.813, together with the new childhood BMI Z-codes, as shown in the above figure.
The new codes will provide:
- Improved accuracy by providing a more precise way to classify obesity that reflect the latest guidelines and recommendations from professional organizations. This includes the American Academy of Pediatrics.
- A more accurate way to measure obesity in claims data. When providers use diagnosic codes for obesity, we will be better able to realize the rates of obesity.
- Enhanced ability to assess medical costs associated with obesity.
- More accurate and clinically relevant terms to help reduce weight stigma and bias and create a more supportive environment for patients.
Providers can start using the new E-codes in combination with the existing Z-codes beginning October 1, 2024. It is important to note that the current E66.01 and E66.9 codes will not be removed according to the NCHS and World Health Organization (WHO) standards. Therefore, providers should become familiar with the new codes and begin to use them. It is also important to share the new codes with your clinical, billing, and electronic health records staff.
It is our hope that you will share these new codes with all providers who treat obesity, as well as with the clinical, billing and electronic health records staff, so that we can begin to ensure providers use the new codes and are reimbursed for the treatment of obesity. Use of these codes will help health plans assess the number of their members affected by obesity and the treatments they receive. This will raise awareness of the disease and lead to an improved quality of care.