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Proper Coding of Adult BMI Assessments

November 5, 2019

Proper coding of Adult BMI Assessment (ABA) decreases the need for medical record review requests and audits by Blue Cross and Blue Shield of Texas (BCBSTX) to comply with Healthcare Effectiveness Data and Information Set (HEDIS®) requirements.

The National Committee for Quality Assurance (NCQA) requires ABA and documentation every two years based on the following:

  • Ages 18 to 19 years: height, weight and BMI percentile
  • Ages 20 to 74 years: weight and BMI

Proper Coding – Tip Sheet

To help with coding, BCBSTX provides a HEDIS BMI Assessment Tip Sheet to know when to submit ICD-10 Z codes for HEDIS BMI reporting in claims.

When are the ICD-10 Z codes used?

Avoid common coding errors from improper use of the Z codes with the following tips:

  • Use an ICD-10 Z code as a secondary code along with a reportable weight diagnosis code such as overweight or obesity.
  • Do not use an ICD-10 Z code as a stand-alone code, they are not reimbursable.
  • If a weight diagnosis cannot be documented, do not use the ICD-10 Z codes.

We appreciate your help in caring for our members, documenting HEDIS data and properly using the associated ICD-10 Z codes for our members.

HEDIS® is a registered trademark of NCQA