P2B302: Utilization of Provider Education with Electronic Medical Record and Web-based Tools to Improve Diet and Activity Counseling in Primary Care, a Quality Improvement Initiative for the Management of Diet Related Chronic Disease

Purpose/Objectives: Pediatric obesity has rapidly grown in prevalence in the U.S. reaching 19.7% in recent reports1. Despite obesity being recognized as a disease, it is often treated as a personal responsibility rather than a clinical diagnosis with specific management guidelines. Nutrition and physical activity counseling are an important component of visits for patients with obesity, highlighting that it is imperative for our providers to code appropriately for their management guidance. Our baseline data found 44% of our visits for patients with obesity included a Z code for BMI and nutrition counseling without an associated E code for reportable weight diagnosis, which is necessary to meet optimal billing guidelines. While it is widely documented that automating billing systems supports long-term sustainable changes, this systems-focused approach was not in use for diet-related chronic diseases, despite being available for other chronic disease management counseling.

Design/Methods: The quality improvement (QI) team aimed to improve coding for BMI, physical activity, and nutrition in two pediatric clinics. The primary outcome measure for this initiative was the percentage of visits in which there was ICD10 coding for nutrition and physical activity. The key process measure was the percentage of visits in which E and Z codes were applied together to the visit. The team implemented the following Plan- Do- Study- Act (PDSA) cycles throughout the project: automating nutrition and physical activity counseling ICD codes in EHR templates, hyperlinking E and Z codes, monthly education sessions for providers on counseling and coding, and monthly coaching on obesity management.

Results: At baseline 13% of the charts incorporated correct ICD10 counseling coding and 40% billed both the E and Z codes appropriately. After implementation of EHR automation and hyperlinking the E and Z codes, both clinic 1 and clinic 2 increased to greater than 90% of visits that included appropriate ICD10 coding and E and Z coding (figure 1, figure 2).

Conclusion/Discussion: Organizations are increasingly held accountable for providing quality, cost-effective care and have developed systems to support caring for patients with chronic diseases. Despite those changes, obesity has continued to be viewed as a personal responsibility and a moral issue, not as a medical diagnosis. Healthcare organizations can shift the dialogue around obesity by implementing sustainable systems-focused approaches to caring for patients with obesity. An imperative step in that process is to support comprehensive automated coding to capture disease management and counseling for patients with obesity to support optimal reimbursement and reduce the administrative burden on providers.