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Developmental-Behavioral Pediatricians' Diagnosis and Coding of Overweight and Obesity in Children with Autism
Morgan Walls1, Carol Curtin2, Sarah Phillips3
1General Academic Pediatrics, Department of Pediatrics, Atrium Health, Charlotte, NC.
Insights
Few children with autism spectrum disorder (ASD) and overweight/obesity received documented weight-related diagnosis codes. Coding was more likely for children with severe obesity, older age, and those on atypical antipsychotics.
Area of Science:
- Pediatrics
- Developmental Pediatrics
- Autism Spectrum Disorder Research
Background:
- Obesity is prevalent in children with autism spectrum disorder (ASD), posing management challenges.
- Accurate coding for overweight and obesity is crucial for patient care and research in ASD.
Purpose of the Study:
- To investigate the coding practices of developmental-behavioral pediatricians (DBPs) for overweight/obesity in children with ASD.
- To identify patient characteristics associated with the documentation of weight-related diagnosis codes.
Main Methods:
- Analysis of clinical data from 4542 children (ages 2-19) with ASD across three network sites.
- Calculation of weight status using BMI z-scores and assessment of weight-related ICD-9 code frequency.
- Multivariable logistic regression to determine factors associated with weight-related coding.
Main Results:
- 15.5% overweight, 14.7% obese, 6.3% severely obese. Only 7.5% of these children had documented weight-related codes.
- Weight-related codes were more frequent in children with obesity/severe obesity and older children.
- Atypical antipsychotic use was associated with higher odds of weight-related coding; only 4% of all diagnosis codes were weight-related.
Conclusions:
- Under-documentation of overweight/obesity is common in children with ASD.
- Factors influencing coding include obesity severity, age, and specific medication use (antipsychotics).
- Improved diagnostic coding for weight status in ASD is needed for better management and research.
Objective:
The prevalence of obesity in autism spectrum disorder (ASD) is high, and managing obesity in children with ASD can be challenging. The study's objective was to examine developmental-behavioral pediatricians' (DBPs) coding practices for overweight/obesity in children with ASD and patient characteristics associated with coding.
Methods:
We analyzed the clinical data on children with ASD with at least 1 visit at one of 3 developmental-behavioral pediatrics network sites between January 2010 and December 2011. Weight status was calculated using body mass index z-scores. For children meeting the criteria for overweight/obesity, we assessed the frequency of weight-related ICD-9 diagnosis codes at DBP visits, used multivariable logistic regression to determine characteristics associated with the presence of these codes, and examined the prevalence of weight-related codes relative to other diagnosis codes.
Results:
The sample included 4542 children, ages 2 to 19 years. 15.5% of children met the criteria for overweight, 14.7% for obesity, and 6.3% for severe obesity. Of children meeting the criteria for overweight/obesity/severe obesity, 7.5% had a weight-related code documented at their visits. Children with obesity or severe obesity and older children had higher odds of having a weight-related code. Compared with not being on medications, atypical antipsychotics use was significantly associated with increased odds of having a weight-related code. Of 3802 unique ICD-9 diagnosis codes documented at any visit during the study period, only 4% were related to weight.
Conclusion:
Few children meeting the criteria for overweight/obesity had documented weight-related codes. Weight-related coding was more likely for children with obesity, who were older, and those taking atypical antipsychotics.
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