Jun 2, 2026 · 31 min · 10 segments
Although one could conclude that artificial intelligence (AI) is a relatively new technology in healthcare, the reality is that AI has been silently working in the shadows for a while now. During the…
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Jerry PetratosGuest
Rose DunnHost
Christine Geiger
Ray Marie JimenezGuest
Chuck BuckHost
[upbeat music] Now is the time for the Talk 10 Tuesday coding report with our good friend, Christine Geiger.
Prior to the IPPS Master Class this August, I will be doing a series of proposed rule previews identifying some proposed code and DRG changes with a focus on our current guidelines and guidance.
First up, Z68.1 Body Mass Index 19.9 or less adult, proposed to be invalid in FY27.
Now, codes may be proposed to be invalid for a number of reasons, one being that there are new proposed codes that offer more specificity or further clarification, and that is indeed the case here.
For FY27, Z68.1 will be replaced by two new codes: Z68.18 Body Mass Index 18.4 or less adult, and Z68.19 Body Mass Index 18.5 to 19, nine adult.
Now, Z68.1 was considered a CC condition and both new codes Z68.18 and Z68.19 will be as well.
Now, this seems to be a very straightforward update that allows for that further specificity in the lower BMI values to be represented.
Our adult BMI codes are assigned for patients 20 years of age and older.
Many patients 18 to 19 years old have moved on from their pediatrician's practice and are now patients of adult general practitioners.
Regardless of where they receive their care, the adult BMI codes can't be assigned until the patient is 20 years old.
As part of last year's final rule, we did get an update to our BMI coding guidelines.
Our guideline update added the example of anorexia to the previous example of obesity, making the guideline inclusive of conditions representing values both high and low.
It also added the guidance that the diagnosis should be documented by the patient's provider, further clarifying that while we can assign the BMI value based on documentation from other clinicians, that corresponding diagnosis must come from the provider.
The next part of the update further instructs that, quote, "When the documentation reflects fluctuating BMI values during the current encounter for an associated reportable condition, assign a code for the most severe value," end quote.
This means the highest or lowest BMI value during the encounter will be assigned.This is another common audit error.
Many facility-specific coding rules instruct their coders to pull the BMI value from the H&P or maybe the dietary evaluation, for example.
While this could have been an attempt for consistency, it no longer follows the official guidelines.
Make sure your coders are aware of this and double-check your facility-specific policies to see if they need to be updated to reflect current guidance.
As part of your review and BMI code assignment, I encourage you and your coding team to re-review Coding Clinic fourth quarter 2018 on this topic.
[upbeat music] Now is the time for the Talk 10 Tuesday coding report with our good friend, Christine Geiger.
Prior to the IPPS Master Class this August, I will be doing a series of proposed rule previews identifying some proposed code and DRG changes with a focus on our current guidelines and guidance.
First up, Z68.1 Body Mass Index 19.9 or less adult, proposed to be invalid in FY27.
Now, codes may be proposed to be invalid for a number of reasons, one being that there are new proposed codes that offer more specificity or further clarification, and that is indeed the case here.
For FY27, Z68.1 will be replaced by two new codes: Z68.18 Body Mass Index 18.4 or less adult, and Z68.19 Body Mass Index 18.5 to 19, nine adult.
Now, Z68.1 was considered a CC condition and both new codes Z68.18 and Z68.19 will be as well.
Now, this seems to be a very straightforward update that allows for that further specificity in the lower BMI values to be represented.
Our adult BMI codes are assigned for patients 20 years of age and older.
Many patients 18 to 19 years old have moved on from their pediatrician's practice and are now patients of adult general practitioners.
Regardless of where they receive their care, the adult BMI codes can't be assigned until the patient is 20 years old.
As part of last year's final rule, we did get an update to our BMI coding guidelines.
Our guideline update added the example of anorexia to the previous example of obesity, making the guideline inclusive of conditions representing values both high and low.
It also added the guidance that the diagnosis should be documented by the patient's provider, further clarifying that while we can assign the BMI value based on documentation from other clinicians, that corresponding diagnosis must come from the provider.
The next part of the update further instructs that, quote, "When the documentation reflects fluctuating BMI values during the current encounter for an associated reportable condition, assign a code for the most severe value," end quote.
This means the highest or lowest BMI value during the encounter will be assigned.This is another common audit error.
Many facility-specific coding rules instruct their coders to pull the BMI value from the H&P or maybe the dietary evaluation, for example.
While this could have been an attempt for consistency, it no longer follows the official guidelines.
Make sure your coders are aware of this and double-check your facility-specific policies to see if they need to be updated to reflect current guidance.
As part of your review and BMI code assignment, I encourage you and your coding team to re-review Coding Clinic fourth quarter 2018 on this topic.
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