Z68.43: Body mass index [BMI] 50.0-59.9, adult

Risk adjustment

Z68.43 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:

• HCC 48 Morbid Obesity0.186 RAF

Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.

Medicare coverage

Z68.43 is named in 13 Medicare coverage policies: 13 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.

• A52447Laparoscopic Sleeve Gastrectomy (LSG) – Medical Policy Article
• A53026Billing and Coding: Bariatric Surgery Coverage
• A54923Billing and Coding: Bariatric Surgery for Treatment of Co-Morbidities Conditions Related to Morbid Obesity
• A56416Billing and Coding: Assays for Vitamins and Metabolic Function