Wiki Class (II, III) Obesity with comorbidity - How many codes to use?

With the new codes giving specifics to reporting obesity by class, it has led to a situation where our EHR system defaults having providers use multiple codes in a way seeming excessive for example:

Class II Severe obesity with comorbidity BMI 38.92
E66.813 (Class II Obesity)
E66.01 (Morbid Obesity)
Z68.39 (BMI)

The question is if the morbid obesity code should/can be kept as part of that set. I think the old justification was that morbid obesity can be inferred from obesity with comorbidity- which never really sat right with several of us even though payers seemed to want coding for obesity with comorbidity as E66.01 when BMI >35. The whole conditional BMI element was already putting it outside of coding guidelines. This doesn't really feel like "upcoding" but it feels like over coding..

Now that there is a distinct code to report the level of obesity, it seems inappropriate/redundant- only E66.813 & the BMI itself seems compliant.

If you think the acrobatics to extract Morbid Obesity from a statement like Class II Severe obesity with comorbidity BMI 38.92 are appropriate, please let me know why and any examples you can if so! I'm really curious. Right now, tending towards just deleting the second, less specific morbid obesity code since the new ones are more specific.

Of course, for HCC purposes that has an impact on risk adjustment. If you ask the Coding Clinic folks they are quick to clarify that we should only code Morbid Obesity when Morbid Obesity is documented, and that BMI should not be kept in mind when assigning an obesity code (only the BMI code). Three codes seems like a stretch..

Happy V28 2025 fellow risk adjustment coders!!

I have a different kind of question about these new codes. One of my providers asked me about this type of scenario:

The patient was seen for weight loss and during the initial visit, they were in class 2 obesity. Now that they have been using medication to aid with weight loss, they are now below the BMI for obesity even, but they are still on the medication for another few months. Do you keep the diagnosis as the original class 2 obesity as that is what they are treating? Because the condition is still being treated, should it be coded as still present? It certainly makes sense that the condition being treated is improving, but obesity is still a chronic condition.