ICD-10 Coding for Wegovy Coverage Beyond Obesity
For a patient seeking Wegovy for cardiac disease prevention, the most appropriate ICD-10 codes beyond obesity are I25.10 (atherosclerotic heart disease of native coronary artery without angina pectoris) or other codes from the I25 series for chronic coronary syndrome, as the 2024 ESC Guidelines now recommend GLP-1 receptor agonist semaglutide for patients with overweight/obesity (BMI >27 kg/m²) and established cardiovascular disease to reduce cardiovascular mortality, MI, or stroke. 1
Primary Cardiovascular ICD-10 Codes for Coverage
Established Cardiovascular Disease
- I25.10 - Atherosclerotic heart disease of native coronary artery without angina pectoris 1
- I25.2 - Old myocardial infarction (if history of prior MI) 2
- I25.5 - Ischemic cardiomyopathy 3
- I50.x series - Heart failure (particularly I50.32 for chronic diastolic/HFpEF or I50.22 for chronic systolic/HFrEF) 3, 4
The SELECT trial specifically enrolled patients with "preexisting cardiovascular disease" defined as prior MI, stroke, or peripheral arterial disease, making these the strongest diagnostic justifications. 2
Supporting Cardiovascular Risk Factor Codes
High-Risk Conditions
- I63.x series - Cerebral infarction (history of stroke) 2, 5
- I73.9 - Peripheral vascular disease 1
- I48.x series - Atrial fibrillation (when present with heart failure) 3
These codes align with the patient population studied in cardiovascular outcome trials where semaglutide demonstrated a 20% reduction in the composite endpoint of cardiovascular death, nonfatal MI, or nonfatal stroke (HR 0.80,95% CI 0.72-0.90). 2
Critical Documentation Requirements
BMI Documentation
Document BMI ≥27 kg/m² alongside cardiovascular diagnosis, as the 2024 ESC Guidelines specifically state semaglutide "should be considered in CCS patients without diabetes, but with overweight or obesity (BMI >27 kg/m²)." 1
Cardiovascular Disease Specification
The cardiovascular disease must be established and documented, not just risk factors. The SELECT trial required objective evidence of preexisting cardiovascular disease, not merely elevated risk scores. 2
Common Pitfalls to Avoid
Do not use diabetes codes (E11.x series) if the patient does not have diabetes, as this creates documentation inconsistency. The SELECT trial specifically excluded patients with diabetes, yet demonstrated cardiovascular benefit. 2
Avoid using only obesity codes (E66.x) without accompanying cardiovascular diagnoses, as payers increasingly require documented cardiovascular disease for non-diabetes indications based on the SELECT trial inclusion criteria. 2
Heart Failure Specific Considerations
For patients with heart failure, semaglutide demonstrated particular benefit with a 28% reduction in MACE (HR 0.72,95% CI 0.60-0.87) and 21% reduction in the composite heart failure endpoint (HR 0.79,95% CI 0.64-0.98) compared to those without heart failure. 3
Use I50.32 (chronic diastolic heart failure) for HFpEF patients, as the STEP-HFpEF trials showed semaglutide improved cardiac remodeling with reduction in left atrial volume (-6.13 mL, P=0.0013) and improved diastolic parameters. 4
Algorithmic Approach to Code Selection
- Primary code: Select from I25.x series if chronic coronary syndrome present 1
- Add I50.x code if heart failure documented (prioritize this given stronger effect size) 3
- Include prior event codes: I63.x for stroke history or I21.x evolved to I25.2 for old MI 2
- Document BMI ≥27 kg/m² as supporting diagnosis (Z68.x series) 1
- Avoid E11.x codes unless diabetes actually present 2
The evidence base is strongest for patients with documented atherosclerotic cardiovascular disease, where semaglutide reduced cardiovascular death by 17% (HR 0.83,95% CI 0.71-0.98) and all-cause mortality by 21% (HR 0.79,95% CI 0.70-0.89). 5