Pediatric Coding Alert

Follow this guide to document the road to recovery.

Princess Diana. Jane Fonda. Lady GaGa. Elton John. We are all familiar with celebrities who have struggled with eating disorders. But many adolescents and young adults, female and male, also find themselves dealing with life-threatening conditions such as anorexia and bulimia.

So, keep the following useful coding information handy when your pediatrician encounters patients seeking help for body issues and problematic relationships with food.

Understand Restriction, Binging, and Purging First

Coding an eating disorder is a relatively straightforward matter, but Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California, cautions that coders need to know the difference between R63.0 (Anorexia) and F50.0- (Anorexia nervosa).

"R63.0 is an unexplained or unknown loss of appetite," she explains, while "anorexia nervosa is 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."

Johnson also reminds coders that they need to be able to distinguish between the two different forms of anorexia - F50.01 (Anorexia nervosa, restricting type) and F50.02 (Anorexia nervosa, binge eating/purging type) - and also between anorexia and F50.2 (Bulimia nervosa). "Restricting indicates that the patient is restricting their food intake," she explains, "whereas binge-eating or purging indicates that the patient is self-inducing vomiting or is misusing laxatives, diuretics, or enemas."

Bulimia nervosa, on the other hand, is a psychological disorder that also involves binging and purging. However, according to Johnson, "a patient with bulimia is a compulsive eater who binges and purges, then has long periods of food restriction between the binge-eating sessions."

So, the weight of the patient is the key to distinguishing between F50.2 and F50.02 as, according to Johns Hopkins Medicine, "when underweight individuals with anorexia nervosa also engage in bingeing and purging behavior, the diagnosis of anorexia nervosa supersedes that of bulimia." Because of this, Johnson offers another reminder that coders will also need to code for the patient's body mass index (BMI) and use the appropriate Z68 (Body mass index [BMI] ...) encounter code.

Physical, Mental Testing Codes Reveal Extent of the Problem

To arrive at a definitive diagnosis, your pediatrician may well perform a number of tests. Typically, they might include

• 85025 - Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count
• 81000-81003 - Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents ...
• 93000, 93005, or 93010 - Electrocardiogram, routine ECG with at least 12 leads ...

Additionally, your pediatrician might administer questionnaires such as SCOFF, the Eating DisorderScreen for Primary Care (ESP), and the Eating Attitudes Test (EAT), which you would document using 96127 (Brief emotional/behavioral assessment (eg, depression inventory, attention-deficit/hyperactivity disorder [ADHD] scale), with scoring and documentation, per standardized instrument) and an encounter code such as Z00.121 (Encounter for routine child health examination with abnormal findings).

Behavior, Nutrition Counseling Point the Way to Recovery

Treatments for each of the conditions mostly involve behavioral and nutritional counseling. When your pediatrician provides such services for an established patient, you'll use the sick visit codes 99212-99215 (Office or other outpatient visitfor the evaluation and management of an established patient ...), using time as the key factor for counseling the patient on ways to recover.

Sharon Britian, CPC, organizational integrity and clinical compliance specialist with PeaceHealth in Vancouver, Washington, also points out that if a pediatrician has a patient or a group of patients that show signs and symptoms of upcoming eating disorders (like loss of weight without a specific diagnosis of anorexia or bulimia), then they may offer risk-factor counseling to sufferers, pointing to services such as 99401-99404 (Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure) ...) or 99411-99412 (Preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure) ...) as additional options. If your pediatrician does decide to go this route, don't forget to add encounter code Z71.3 (Dietary counseling and surveillance) to conclude your reporting.