Pediatric Coding Alert

Condition Spotlight:

Use This Guide, Stay in Shape With Your Eating Disorder Coding

Published on Tue May 10, 2022

Hot tip: remember to add BMI codes when appropriate

“Fifty percent of girls and 30 percent of boys use unhealthy weight control behaviors, and three percent of all teenage girls struggle with eating disorders” because “circumstances are so difficult that a person is using food — either restricting, binging, purging, or overeating — to provide some level of control over their lives,” said Pam Brooks, MHA, COC, PCS, CPC, AAPC Fellow at MaineHealth in Portland Maine, during her HealthCon 2022 presentation “Eating Disorders: When Food Is the Enemy.”

The presentation outlined a number of the most common eating disorders, and some of the less common ones, that you may be called upon to code. Here’s what you need to know.

Anorexia nervosa

What is it? Like all eating disorders, anorexia nervosa is “a complex mental health condition with medical, physiological, and nutritional implications,” Brooks explained. This explains why you will find it, and the majority of eating disorder codes, in the Mental, Behavioral and Neurodevelopmental chapter of ICD-10.

The condition involves the patient being considerably underweight, having a distorted body image, and most important, restricting food intake.

How is it coded? As most anorexia cases involve restricting food intake, this will usually lead you to choose F50.01 (Anorexia nervosa, restricting type). However, you will need to closely examine your pediatrician’s notes to make sure F50.01, and not F50.02 (Anorexia nervosa, binge eating/purging type), is the correct code to use.

F50.01 “indicates that the patient is restricting their food intake, whereas binge-eating or purging [F50.02] indicates that the patient is self-inducing vomiting or is misusing laxatives, diuretics, or enemas,” cautions Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow billing/ credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California.

Avoid this coding confusion: If your provider documents that the causes of the patient’s anorexia are “unexplained or unknown loss of appetite,” the appropriate code choice may be R63.0 (Anorexia) according to Johnson.

In fact, R63.0 is one of the Excludes1 codes for the entire group of F50.- (Eating disorders) codes, so be sure to check with your pediatrician whenever the cause of the patient’s anorexia remains undetermined.

Bulimia nervosa

What is it? “This is where people eat an unusually large amount of food — thousands and thousands of calories in a specific time — followed by some method of purging such as laxative abuse, vomiting, extreme exercise, diuretics, enemas, or fasting. The difference between a bingeing episode and these episodes is that they recur over and over more than once or twice a week, and that’s generally the criteria for diagnosis,” said Brooks.

How is it coded? For this diagnosis, you’ll simply use F50.2 (Bulimia nervosa). But once again, Excludes instructions come into play, and you’ll need to use F50.02 if your pediatrician documents both conditions.

Binge eating disorder

What is it? This condition is “the most common eating disorder in the United States,” according to Brooks. Individuals with the disorder exhibit the “constant and prolonged behavior” of consuming “unusually large amounts of food in a relatively short period of time, but they don’t purge, and they don’t restrict calories,” distinguishing the condition from anorexia nervosa and bulimia nervosa, Brooks notes.

How is it coded? F50.81 (Binge eating disorder).

Pica

What is it? The condition “usually manifests itself in individuals who crave nonfood substances like dirt and rocks and sheet rock,” said Brooks.

How is it coded? The important consideration for correct code choice in a pica diagnosis lies in the age of the patient. ICD-10 does not provide specific age guidelines, but the synonym Pica in adults leads you to F50.89 (Other specified eating disorder) for the adult version of the condition, while you’ll move out of the F50.- codes and chose F98.3 (Pica of infancy and childhood) for cases of pediatric pica.

Other eating disorders

Rumination disorder involves regurgitating or vomiting up a food that has been previously chewed and swallowed; the food is then rechewed and swallowed or spit out. In older patients, you’ll use the signs and symptoms code R11.10 (Vomiting, unspecified), but for infants, the correct code choice is F98.21 (Rumination disorder of infancy).

Avoidant restrictive food intake disorder is a condition where individuals have a limited range of preferred foods that progressively worsens, causing dramatic weight loss and often fear of choking or vomiting,” according to Brooks. The condition is coded to F50.82 (Avoidant/restrictive food intake disorder).

Orthorexia is “an obsessive focus on healthy eating to the point where it disrupts a patient’s daily life, so they can’t eat anything because there’s nothing available that they can eat,” said Brooks. As there is no current ICD-10 code for the condition, the best alternative to document the diagnosis would be F50.89.

And Don’t Forget This Final Eating Disorder Coding Tip

As many of these conditions result in your patient’s becoming underweight, you should assign an additional code to document the patient’s body mass index (BMI), Brooks suggests.