By Kelley Hazell, MDS Resource
Morbid Obesity may be prevalent in over 10% of older adults, but how do we determine if the condition is not only present, but active? Remember our PDPM Newsletter on How to Be Active? The RAI Manual requires two things:
A physician must have confirmed that the diagnosis has been present within the last 60 days
They must meet the RAI definition of an active condition: Diagnoses that have a direct relationship to the resident’s current functional, cognitive, or mood or behavior status, medical treatments, nursing monitoring, or risk of death during the 7-day lookback period
PDPM Update Alert: Effective 10/1/24 there are several new ICD-10 codes to describe morbid obesity, and one of them is included in the NTA list. Obesity, Class 3 (Class III), E66.813 is now on the NTA list in the morbid obesity category. According to the Cleveland Clinic, Class III obesity is diagnosed when patients:
Are 100 pounds over the optimum body weight range for their sex and height.
Have a BMI of 40 or more.
Have a BMI of 35 or more and are experiencing obesity-related health conditions, such as high blood pressure or diabetes.
While diagnosing Morbid Obesity when these conditions exist has always been an option, the new ICD-10 code is a little clearer and may result in more straightforward communications with the physician.
While confirming the presence of the diagnosis with the physician is usually the easy part, how do we determine if Morbid Obesity meets the RAI definition of an active condition impacting the resident during the lookback?
Complications of obesity and morbid obesity can impact almost every organ system, and the direct relationship to the patient’s needs could be easier to see than we think!
Did you know….
Obesity is a leading risk factor of Osteoarthritis in the knees, hips and ankles? Osteoarthritis causes pain, swelling, stiffness and reduced motion in joints. This could potentially impact a resident’s therapy goals, treatment plan, progress, and ability to participate in ADLs. They could experience increased pain and the need for increased pain management interventions. What could be presumed to directly correlate to Osteoarthritis may also have a direct relationship to the presence of Morbid Obesity.
Obesity has been linked to not only Cognitive Decline, but also other brain disorders such as Dementia, Anxiety and Depression. Obesity-derived vascular problems are known to disrupt blood vessels that feed the brain, contributing to cognitive impairment, and altering executive function and short-term memory.
Obesity may also play a role in various Liver Diseases. Not only causing Non-Alcoholic Fatty Liver Disease, Obesity may also diminish the state of patients with other existing Liver Diseases and is a strong risk factor for Liver Cancer.
Obesity impacts how well your lungs work. Excess weight increases breathing problems and is a common cause of Sleep Apnea. Obesity not only increases the risk of developing Asthma, but it also may cause increased difficulty in managing the symptoms of Asthma or other Chronic Lung Diseases.
Obesity is commonly associated with Cardiovascular Disease and Diabetes, but did you know that Obesity can also increase your risk of developing Chronic Kidney Disease, or progress an existing CKD, even in the absence of Diabetes or Hypertension?
Daily Technical Meeting (PDPM) is the perfect place to look at your resident’s conditions through the various lenses of each Interdisciplinary Team member and put these pieces together.
Is Morbid Obesity currently having a direct relationship on your resident’s functional, cognitive, mood or behavior status, medical treatments, nursing monitoring, or risk of death during the 7-day lookback period? Do you have interventions in place because of this condition? Interventions could mean equipment outside of standard equipment: Modified or Bariatric Bed, Modified or Bariatric Wheelchair, bed extenders to widen the perimeter, Bariatric or Wide Walker, Modified Shower Chair, the inability to utilize a Shower Chair and requiring a Shower Bed/Stretcher. Interventions can also occur outside of providing equipment: tying together the overall picture of the resident and how the presence of Morbid Obesity is impacting their progress or treatment plan in therapy, pain management, nutritional approaches, respiratory management, renal management, cardiovascular management, cognitive status, mood/anxiety/depression, skin management interventions in place due to larger body habitus, etc.
Supporting these interventions through documentation is a key element. Documentation in Therapy Evaluations, Therapy Treatment Encounter Notes, Nursing Progress Notes, Nursing Daily Skilled User-Defined Assessments, Physician’s Orders, and updating the Plan of Care during the Daily Technical Meeting (PDPM) will ensure the impact and services the facility is providing are supported.
Having a robust discussion as a team will help clear the path to determining if Morbid Obesity is actively impacting the resident today.
For more information on Morbid Obesity, check out the previous PDPM Newsletter: PDPM 2.0 Newsletter 40 PDPM Morbid Obesity v 2.pdf
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