ICD-10-CM codes Supporting Wegovy (semaglutide) for Obesity
Wegovy approval for chronic weight management in adults requires an initial BMI of ≥30 kg/m² (obesity) or ≥27 kg/m² with at least one weight-related comorbid condition. [1]
ICD-10-CM documentation for obesity typically uses an E66.x obesity diagnosis code paired with the appropriate Z68.x BMI code. [2]
Obesity diagnosis (E66.x) options
- E66.9 Obesity, unspecified [2]
- E66.8 Other obesity [2]
BMI documentation (Z68.x) options for adult patients
- Z68.30–Z68.39 Body mass index (BMI) 30.0–39.9, adult (includes obesity BMI 30–39.9) [2]
- Z68.4 Body mass index (BMI) 40 or greater, adult (severe obesity BMI ≥40) [2]
Practical coding pattern used for prior authorization requests
- Use an E66.x obesity diagnosis code together with the corresponding Z68.x BMI code. [2]
Wegovy obesity indication criteria to align coding with
- Adults: initial BMI ≥30 kg/m² for obesity. [1]
- Adults: initial BMI ≥27 kg/m² with at least one weight-related comorbid condition (examples include hypertension, type 2 diabetes mellitus, and dyslipidemia). [1]
Example ICD-10-CM code sets for common prior authorization scenarios
- Adult with BMI 32: E66.9 + Z68.30–Z68.39. [2]
- Adult with BMI 38 and obesity: E66.9 + Z68.30–Z68.39. [2]
- Adult with BMI 45: E66.9 + Z68.4. [2]
Key exclusions for obesity coding
- Codes such as E66.0 “Obesity due to excess calories” and E66.01 “Severe obesity due to excess calories” are commonly flagged as codes to avoid for obesity management coding in tip sheets. [2]
Important documentation detail for approval
- BMI documentation should be consistent with the patient’s measured BMI at the time treatment is being justified. [1]