Coding for Weight Loss:
Use Anorexia Nervosa Diagnosis Code with Caution
Published on Sun Nov 01, 1998
There is sometimes confusion about how to code weight loss. Were not doing a clinical story here; its up to the pediatrician to decide what the correct diagnosis is.
Coders should make sure they communicate with the provider to make sure they are coding the correct diagnosis. And, particularly in these cases, providers should make sure their documentation details the problem they are treating, even if the patient may suffer from a more complicated illness. With some codes, there are ramifications to the practice and to the patient that might not be readily apparent.
First of all, here are the commonly used codes when a patient is seen who demonstrates significant weight loss:
783.0 Anorexia (Loss of appetite)
783.2Abnormal loss of weight
307.1Anorexia nervosa
307.1 Is Considered Mental Disorder
Note that 307.1 excludes eating disturbance NOS (307.50), feeding problem (783.3), feeding problem of nonorganic origin (307.59), loss of appetite (783.0), and loss of appetite of nonorganic origin (307.59).
For coders, the problem is further compounded by the fact that anorexia nervosa is sometimes casually referred to as anorexia. But, there is a world of difference between the two codes. Anorexia nervosa is listed under mental disorders, which, for many insurance carriers, puts it in an altogether different category from every other medical diagnosis.
One problem that happens when billing for mental disorders is that the [insurance] company may not pay you, says Terry Pereira, practice manager for Highland Pediatrics, an eight-pediatrician practice in Fall River, MA. If youre not listed as a mental health provider with the insurance company, theyll reject it, says Pereira.
If the pediatrician diagnoses a child with anorexia nervosa, the practice should refer the child to a mental health provider, says Pereira. Once theyre diagnosed, we get them hooked up with a specialist, she explains.
Another problem with using 307.1 as a diagnosis code is that it can have adverse consequences for the patient in the future. This is because of the unfortunate discrimination against mental illness which occurs in the insurance industry. I would not use anorexia nervosa on a routine basis, says Charles M. Vanchiere, MD, FAAP, chair of the RBRVS PAC of the American Academy of Pediatrics and CEO of the Childrens Clinic of SW Louisiana in Lake Charles. The code has long-term effects on insurability. Usually, Vanchiere would use 783.2 (abnormal loss of weight). I would only use anorexia nervosa after a comprehensive evaluation by the pediatrician or a psychiatrist.
Other Diagnosis Options
Garry Sigman, MD, director of adolescent medicine at Lutheran General Childrens Hospital in Park Ridge, IL, agrees that anorexia nervosa is not a routine diagnosis. In fact, he doesnt think it can be treated by a pediatrician alone, and therefore he doesnt use 307.1. Here is his [...]
