Pediatric Coding Alert

Answer: To answer this question, let’s first identify the three codes to which you’re referring.

• F50.2 (Bulimia nervosa)
• F50.81 (Binge eating disorder)
• F50.02 (Anorexia nervosa, binge eating/purging type)

In lay terms, bulimia describes someone who binges on food then self-induces vomiting or misuses laxatives, diuretics, or enemas to quickly get rid of what they’ve eaten. When to use each of these codes will depend on the patient’s behaviors but it could also depend on their weight.

The patient record for a patient suffering bulimia nervosa will include notes on compulsive binge eating and purging. For that, you’ll report F50.2. If the patient record describes binging and purging but also excessive exercise, long stretches without eating, and extremely low weight, that is coded to F50.02. The physician is describing a combination condition where the patient cycles between anorexia (starving themselves, excessively exercising) and bulimia. Excludes1 instructions point to the difference, as they tell you not to report F50.2 with F50.02 and vice versa.

You’ll turn to F50.81 when a patient binge eats but does not purge. Many of these patients will be overweight because they’re simply eating too much in one sitting too often.

Note: As always, if ever the physician’s notes are unclear or seem discrepant, follow up with a query so you’re sure to assign the accurate code.