Z68.42

Billable

Body mass index [BMI] 45.0-49.9, adult

HCC Category Mapping

V28HCC 48 — Morbid Obesity

0.226

V24HCC 22 — Morbid Obesity

0.250

ESRDHCC 22 — Morbid Obesity

0.000

What This Code Means

A measurement of body weight relative to height (BMI) between 45.0 and 49.9 in adults, indicating severe obesity.

Coding Tips

•BMI codes are status codes used for documentation purposes and should be reported alongside the diagnosis of obesity (E66.x) when applicable
•Ensure the BMI calculation is documented in the medical record; these codes require actual BMI values, not estimates

Clinical Significance

This code indicates severe obesity with BMI 45.0-49.9, representing very significant health risk requiring intensive medical management and intervention. Morbid obesity at this level substantially increases risk for cardiovascular disease, diabetes, sleep apnea, and other complications requiring comprehensive care coordination.

Documentation Requirements

✓Documented BMI calculation between 45.0-49.9
✓Patient age confirmed as adult (18+ years)
✓Height and weight measurements supporting BMI calculation
✓Clinical assessment of obesity-related health impacts
✓Provider documentation of obesity as medical condition
✓Associated comorbidities or complications noted
✓Treatment plan or interventions discussed
✓Bariatric surgery evaluation or referrals if appropriate

Commonly Confused Codes

Z68.41 — Use when BMI is 40.0-44.9 instead of 45.0-49.9 Z68.43 — Use when BMI is 50.0-59.9 instead of 45.0-49.9 E66.01 — Use for morbid obesity due to excess calories, not BMI code alone Z68.54 — Use for pediatric BMI >95th percentile, not adult BMI Z68.39 — Use when BMI is 35.0-39.9 (obesity Class II)

Code Hierarchy

└Z68Body mass index [BMI]└Z68.4Body mass index [BMI] 40 or greater, adult └Z68.42Body mass index [BMI] 45.0-49.9, adult

└Z68.42Body mass index [BMI] 45.0-49.9, adult