Undertreating childhood obesity may be tied to payment codes, and specifically the perception of pediatricians that the ICD-9 diagnosis code for obesity (278.00) is not covered and that using it will result in nonpayment of services, according to Sarah Hampl, MD, assistant professor of pediatrics at the University of Missouri-Kansas City School of Medicine.
Hampl and colleagues conducted a large retrospective study of claim data for 8,404 children that revealed that the increased health care utilization and charges that have been reported for obese adults are also present for obese children. The researchers compared the utilization and expenditures for healthy-weight patients, overweight patients, and patients with diagnosed and undiagnosed obesity.
Even if the child is obese, the diagnosis code is still not used. In the study, in only about 42 percent of claims did the provider use the diagnosis code for obesity when it should have been applied based on the child’s body mass index.
In the current coding situation, “insurers cannot see that more claims for obese children should be submitted. It is a shame, but it appears that the child must develop a comorbidity that can be coded for before the visit will be reimbursed,” says Hampl.
“Given the likelihood that obesity and its comorbidities will track into adulthood, the costs for obese children will continue to climb,” says Hampl.
She recommends spending money now “to identify comorbidities in obese children to try to treat them and the underlying obesity in the hopes that further morbidity, disability, and death will not occur.”
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