If you want to conquer the bariatric market, know the codes, make thorough assessments, and show sensitivity toward your patients.

According to the National Health and Nutrition Examination Survey 2003 to 2004, about one third of US adults are overweight, and almost a third are obese. The National Institutes of Health has developed a diagnostic category recognizing obesity as a multifactorial disease.

As obesity has increased in the United States, meeting needs has become more challenging. The first step in meeting the physical needs of the morbidly obese is to complete a thorough assessment. Part of this assessment will include determining the person's ability to perform activities of daily living (ADL) and mobility-related activities of daily living (MRADL) independently.

EQUIPMENT NEEDS

The physical needs of the morbidly obese can change over time. Initially, it may be possible to maintain independence. However, as weight increases or complications occur as a result of chronic health problems, many individuals may need specialty equipment. Financing special equipment can be a concern for patients.

There is some government reimbursement through CMS for certain equipment with a physician's order. The equipment has been designed to handle patients that weigh up to 600 pounds and 600 to 1,000 pounds. It is important to consider both the shape of the individual and the patient's weight when choosing the equipment. If the medical device is not designed to maintain a certain weight, the equipment might break or the patient or caregiver may be injured. Listed below are some medical devices that may be reimbursed by CMS (depending on various factors).

Walkers: A walker may be one of the first pieces of equipment an obese person may need. To qualify for a walker, the person must have a significant mobility limitation that prevents them from completing MRADLs in a safe and reasonable time frame. The billing codes for a heavy-duty walker—for people weighing more than 300 pounds—are EO147, EO148, and EO149.

Wheelchairs: Once a walker is no longer adequate and MRADLs have been entirely limited, or can't be completed in a reasonable amount of time, it is time to consider a wheelchair. The person's home must be able to accommodate a wheelchair with adequate door openings, space to turn, and ramps to enter and exit the home if desired. For people over 250 pounds, use code 0006. Use of code K0007 is for people more than 300 pounds.

Commodes: An extrawide/heavy-duty commode may be covered when a person is unable to ambulate to another floor or another room to use the toilet. Code EO168 is used for commode chairs that are able to support patients weighing 300 pounds or more. The width of these chairs is 23 inches or more.

Hospital beds: Fixed-height hospital beds are covered if patients have a medical condition that requires them to be positioned in ways not possible with a standard bed. Other qualifications are to help alleviate pain or raise the head of the bed greater than 30 degrees due to chronic cardiac conditions, pulmonary factors, or risk of aspiration. For patients who weigh between 350 and 600 pounds and need a heavy-duty extrawide hospital bed with side rails (but no mattress), the code is EO301. With a mattress, the code is EO303. For patients who weigh more than 600 pounds, use code EO302 for a heavy-duty extrawide hospital bed with side rails (but no mattress) or EO304 for a heavy-duty extrawide hospital bed with side rails (with a mattress).

Jeanne Perla, PhD, RN

Semielectric beds may be covered, but totally electric hospital beds are considered a convenience feature, and are reimbursed at the least costly medically appropriate rate. Specialty mattresses and overlays are reimbursed based on group qualifications. Currently, there are no special codes for requesting bariatric specialty support surfaces or overlays.

Trapeze: A trapeze will be covered if patents need this device to help sit up because of respiratory issues, to change body positions, or to get in and out of bed. A heavy-duty trapeze should be used when the patient weight is greater than 250 pounds. Use EO911 if the trapeze needs to be attached to the bed or EO912 if it is freestanding.

Patient lifts: There is no special reimbursement code for patient lifts. Indications for patient lifts are the same regardless of the patient's weight. Code 0630 provides a lift if a person would be restricted to a bed and if transfer between a bed and chair requires more than one person. Code 0621 is used for the sling or seat section.

THE STEPS TO SUCCESS

The key to reimbursement is documentation. It is essential that the patient's needs are accurately assessed and documented with a written, signed, and dated order. Educating the patient and caregiver on how to safely use special equipment will help maintain a bariatric person's dignity and ensure the patient's and caregiver's safety by preventing injury.

The second step is to meet the emotional needs of the morbidly obese. The bariatric patient's emotional needs are equally great. It is not uncommon for obese people to be depressed and socially isolated. The general population may respond to the morbidly obese person with "lookism" and "otherness." Lookism is discrimination or prejudice against people based on their appearance. Otherness in health care may result in clinicians not planning and providing adequate care because they blame patients for the problems they are experiencing.

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One study found that 63% of physicians felt that obese patients lacked will power and 33% thought their patients were lazy. Sensitivity training may help staff members to identify negative feelings they may have toward obese people. Once these negative feelings are identified, classes that focus on empathy should be attended by all caregivers.

Ultimately, caregivers must examine their own feelings before they provide care for the morbidly obese. If concern is for the safety of patients and caregivers, appropriate medical devices can eliminate some of these fears.

Jeanne Perla, PhD, RN, is senior research scientist at Gaymar Industries Inc, Orchard Park, NY. She is responsible for research and education on pressure ulcers and temperature management. Perla can be reached via e-mail: .