Pediatric Coding Alert

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 reasoning. Anorexia nervosa and bulimia nervosa are complex biopsychosocial disorders that always demand a team approach, says Sigman, who is also a professor in the Department of Pediatrics at the University of Illinois in Chicago. If the diagnosis is correct, categorically a mental health professional needs to be involved. Sigman is not a mental health professional, so he doesnt use mental disorders codes. I only use biomedical codes, he says.

What diagnosis codes should you use when the patient has anorexia nervosa? You could go through a long list of the medical problems associated with the disease, he says. There is absence of menstruation (626.0), bradycardia (427.89), or hypothermia (780.9), to name a few. What about weight loss? Be very careful with using that for more than the first few visits, says Sigman. You can only use weight loss once or twice, he says. Thats because you need to find the cause. Youd be a bad doctor if you saw a patient 12 times for weight loss. If the diagnosis is weight loss, and its caused by non-medical factors, the pediatrician should refer the patient to a mental health professional, says Sigman. But it could be something other than anorexia nervosa, he adds. It could be major depression, or phobic swallowing, or something else.