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v1.0.0
ICD-10 Guide
ICD-10 CodesE66.813

E66.813

Billable

Obesity, class 3

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 E66.813 is a billable code used to indicate a diagnosis of obesity, class 3.

Key Diagnostic Point:

Obesity, class 3, also known as severe obesity, is defined by a Body Mass Index (BMI) of 40 or greater. This condition is characterized by excessive body fat that significantly increases the risk of various health complications, including cardiovascular diseases, type 2 diabetes, hypertension, and certain types of cancer. Class 3 obesity is often associated with metabolic syndrome, which encompasses a cluster of conditions that occur together, increasing the risk of heart disease, stroke, and diabetes. Patients with class 3 obesity may experience physical limitations, psychological issues, and a decreased quality of life. Management of class 3 obesity typically involves a multidisciplinary approach, including lifestyle modifications, behavioral therapy, pharmacotherapy, and possibly surgical interventions such as bariatric surgery. Accurate coding of this condition is crucial for appropriate treatment planning and reimbursement, as it reflects the severity of the patient's obesity and associated health risks.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in BMI calculations and classifications
  • Need for comprehensive documentation of comorbidities
  • Potential for misclassification with other obesity codes
  • Documentation of weight management strategies

Audit Risk Factors

  • Inadequate documentation of BMI measurements
  • Failure to document obesity-related comorbidities
  • Incorrect coding of obesity class
  • Lack of evidence for weight management interventions

Specialty Focus

Medical Specialties

Endocrinology

Documentation Requirements

Detailed documentation of BMI, comorbidities, and treatment plans.

Common Clinical Scenarios

Management of diabetes and metabolic syndrome in obese patients.

Billing Considerations

Endocrinologists should document hormonal evaluations and metabolic assessments.

Bariatric Surgery

Documentation Requirements

Comprehensive pre-operative assessments and post-operative follow-ups.

Common Clinical Scenarios

Patients seeking surgical intervention for severe obesity.

Billing Considerations

Documentation must include justification for surgery based on BMI and comorbidities.

Coding Guidelines

Inclusion Criteria

Use E66.813 When
  • According to the official coding guidelines, E66
  • 813 should be used when the patient's BMI is documented as 40 or greater
  • Coders must ensure that the diagnosis is supported by clinical documentation and that any associated conditions are also coded appropriately

Exclusion Criteria

Do NOT use E66.813 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

43644CPT Code

Laparoscopic gastric bypass

Clinical Scenario

Used for patients with class 3 obesity seeking surgical intervention.

Documentation Requirements

Pre-operative assessments, BMI documentation, and comorbidity evaluations.

Specialty Considerations

Bariatric surgeons must ensure comprehensive documentation to support surgical necessity.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of obesity classes, improving the accuracy of health records and reimbursement processes. E66.813 provides a clear indication of severe obesity, which is crucial for treatment planning and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of obesity classes, improving the accuracy of health records and reimbursement processes. E66.813 provides a clear indication of severe obesity, which is crucial for treatment planning and resource allocation.

Reimbursement & Billing Impact

reimbursement processes. E66.813 provides a clear indication of severe obesity, which is crucial for treatment planning and resource allocation.

Resources

Clinical References

  • •
    Obesity Management Guidelines

Coding & Billing References

  • •
    Obesity Management Guidelines

Frequently Asked Questions

What is the significance of coding E66.813?

Coding E66.813 accurately reflects the severity of a patient's obesity, which is critical for appropriate treatment planning and reimbursement. It also helps in tracking obesity-related health outcomes.