ICD-10 Coding for Morbid Obesity with Laparoscopic Gastric Sleeve
For a patient with morbid obesity undergoing laparoscopic gastric sleeve (sleeve gastrectomy), use ICD-10 code E66.01 (Morbid obesity due to excess calories) as the primary diagnosis code.
Primary Diagnosis Code
- E66.01 is the appropriate code for morbid obesity (BMI ≥40 or BMI ≥35 with obesity-related comorbidities) when the patient is undergoing bariatric surgery 1
- This code specifically captures "morbid (severe) obesity due to excess calories," which is the standard diagnosis justifying sleeve gastrectomy 1
Additional Required Codes
BMI Documentation
- Z68.4x codes should be added to document the specific BMI value:
- Z68.41 (BMI 40.0-44.9)
- Z68.42 (BMI 45.0-49.9)
- Z68.43 (BMI 50.0-59.9)
- Z68.44 (BMI 60.0-69.9)
- Z68.45 (BMI 70 or greater)
- These BMI codes provide essential documentation for medical necessity 1
Obesity-Related Comorbidities
Document all present comorbidities with their specific ICD-10 codes, as these justify surgical intervention at lower BMI thresholds (≥35) 1:
- E11.x for Type 2 diabetes mellitus (remission occurs in 56-90% post-surgery) 2
- I10 for essential hypertension (remission in 54-76% of cases) 2
- G47.33 for obstructive sleep apnea (remission in 43-74% of patients) 2
- E78.x for dyslipidemia/hyperlipidemia 1
- K21.9 for gastroesophageal reflux disease (GERD) - note this is a relative contraindication for sleeve gastrectomy 1
- K76.0 for nonalcoholic fatty liver disease 1
- M17.x for osteoarthritis of weight-bearing joints 1
Procedure Code Context
While you asked about diagnosis codes, the corresponding CPT procedure code is 43775 for laparoscopic sleeve gastrectomy (vertical sleeve gastrectomy), which involves removal of approximately 85% of the stomach along the greater curvature 1, 3.
Critical Documentation Requirements
Ensure medical necessity is clearly documented by including:
- Current BMI ≥35 (or ≥30 with metabolic disease per updated 2023 guidelines) 1
- Duration of obesity
- Failed attempts at nonsurgical weight management 1
- Presence and severity of obesity-related comorbidities 1
- Absence of contraindications (active Barrett's esophagus, refractory GERD) 1
Common Coding Pitfalls
- Do not use E66.9 (obesity, unspecified) when the patient clearly meets morbid obesity criteria - this undermines medical necessity 1
- Always include the Z68.4x BMI code - missing this can result in claim denials
- Document all comorbidities separately rather than assuming they're implied by the morbid obesity code 1
- Avoid using E66.2 (morbid obesity with alveolar hypoventilation) unless obesity hypoventilation syndrome is specifically diagnosed 1