Z68.56

Billable

Body mass index [BMI] pediatric, greater than or equal to 140% of the 95th percentile for age

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 child has severe obesity at the highest level, with weight far exceeding the healthy range for their age, indicating the most serious pediatric obesity classification.

Coding Tips

•Document when BMI is 140% or greater of the 95th percentile for age and sex
•This indicates Class 3 obesity; strongly consider documenting metabolic complications and specialist referrals

Clinical Significance

This code indicates the most severe level of pediatric obesity with BMI ≥140% of 95th percentile for age, representing extreme health risk in children requiring immediate intensive medical management. Severe pediatric obesity at this level significantly impacts growth, development, and long-term health outcomes.

Documentation Requirements

✓Documented pediatric BMI ≥140% of 95th percentile for age
✓Patient age confirmed as pediatric (under 18 years)
✓Age-appropriate BMI percentile calculations
✓Growth chart documentation with percentile plotting
✓Assessment of obesity-related health impacts in children
✓Family history and environmental factors documented
✓Multidisciplinary pediatric obesity treatment plan
✓Specialist referrals to pediatric endocrinology or obesity programs

Commonly Confused Codes

Z68.41-45 — Use for adult BMI codes, not pediatric patients Z68.54 — Use when BMI is 120-139% of 95th percentile instead of ≥140%Z68.53 — Use when BMI is 95th-119% of 95th percentile E66.01 — Use for morbid obesity due to excess calories Z68.52 — Use when BMI is 85th-94th percentile

Code Hierarchy

└Z68Body mass index [BMI]└Z68.5Body mass index [BMI] pediatric └Z68.56Body mass index [BMI] pediatric, greater than or equal to 140% of the 95th percentile for age

└Z68.56Body mass index [BMI] pediatric, greater than or equal to 140% of the 95th percentile for age