Primary Care Coding Alert

Coding Quiz Answers:

Check Your Answers to Our Eating Disorders Quiz

Published on Wed Jan 19, 2022

See how well you can match these clinical conditions to their ICD-10 codes.

Once you’ve answered the quiz questions on page 3, compare your answers with the ones provided below:

Answer 1: For anorexia, ICD-10 lists F50.0- (Anorexia nervosa) and R63.0 (Anorexia). The clue to distinguishing between them lies in knowing the codes for anorexia nervosa belong in the Mental, Behavioral and Neurodevelopmental Disorders chapter of ICD-10, whereas R63.0 is a signs and symptoms code, meaning it “does not represent a patient with a psychological eating disorder,” according to JoAnne M. Wolf, RHIT, CPC, CEMC, coding manager at Children’s Health Network in Minneapolis, Minnesota.

In fact, R63.0 is appropriate for “an unexplained or unknown loss of appetite,” whereas F50.0- is appropriate for “a psychological development disorder where the patient fears becoming overweight and develops a distorted self-image of the body to the point of starvation or malnutrition,” according to Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/ credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California.

Excludes1 instruction illustrates the difference: To reflect the fact that the two conditions have different causes, ICD-10 guidelines make R63.0 an Excludes1 code for all the F50.- (Eating disorders) codes, and F50.0- an Excludes1 subcategory for R63.0. In other words, “the excludes notes for both codes direct you to one chapter or the other, not both,” notes Wolf.

Answer 2: Three different codes represent bulimia, a condition which describes “a compulsive eater who binges then purges, which means the patient is self-inducing vomiting or is misusing laxatives, diuretics, or enemas,” explains Johnson. To distinguish between F50.2 (Bulimia nervosa), F50.81 (Binge eating disorder), and F50.02 (Anorexia nervosa, binge eating/ purging type), your provider will look at a patient’s weight and behaviors.

“Bulimia nervosa, F50.2, involves compulsive binge eating and purging, and F50.02 is similar in that it involves binging and purging. [For F50.02], patients are often extremely underweight and will exhibit other symptoms of anorexia nervosa, such as excessive exercising and long stretches without eating. Code F50.81 represents an eating disorder that involves binge eating without purging, resulting in many patients being overweight,” Wolf adds.

Again, Excludes1 instructions point to the difference, as they tell you not to report F50.2 with F50.02 and vice versa.

Answer 3: OSFED, or Other Specified Feeding or Eating Disorders, consist of atypical anorexia nervosa, bulimia nervosa of low frequency and/or limited duration, binge eating disorder of low frequency and/or limited duration, purging disorder, and night eating syndrome.

Only the first of the OSFED conditions, atypical anorexia nervosa, has an assigned ICD-10 code. “The alphabetical index points you to F50.9 (Eating disorder, unspecified), which is listed as an example for this code,” Wolf notes. Should your provider document any of the other OSFED conditions, you would report them with F50.89 (Other specified eating disorder).

Answer 4: ARFID is an acronym for Avoidant Restrictive Food Intake Disorder, which is an eating disorder that does “not meet criteria for traditional eating disorders such as anorexia nervosa and bulimia nervosa,” according to AHA ICD-10-CM Coding Clinic (Volume 4, Number 4, 2017). Unlike those conditions, patients diagnosed with ARFID show “no evidence of a disturbance in body perception.” The condition results in “a persistent failure to meet appropriate nutritional and/ or energy needs through an individual’s diet” and “may be caused by difficulty digesting certain foods, avoiding food with certain textures, smell or colors, portion size, lack of appetite, or fear of repeating a bad experience with certain foods,” Coding Clinic states. The code for ARFID is F50.82 (Avoidant/ restrictive food intake disorder).

Answer 5: Pica is a condition in which a patient eats items that have no nutritional value, such as dirt, hair, or paint, due to pregnancy, malnutrition, or iron-deficiency anemia. With pica, the coding challenge is to make sure you choose the age-appropriate code. You’ll choose the “other specified” code F50.89 if the condition occurs in adulthood, as one of the code’s synonyms — pica in adults — suggests. For childhood pica, you’ll choose F98.3 (Pica of infancy and childhood).

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