Pediatric Coding Alert

Hint: Distinguish from binge eating or purging type to nail the ICD-10 diagnosis.

When the pediatrician diagnoses an eating disorder, you’re currently quite familiar with the 307.xx series of ICD-9 codes, but your options won’t change too dramatically under ICD-10, which will offer a fairly easy transition to your coding strategy.

Capture This Bulimia Change

ICD-9: You currently use 307.51 (Bulimia nervosa) to report a diagnosis of bulimia nervosa. You use the same diagnosis code if the pediatrician mentions the diagnosis as overeating of nonorganic origin. However, you cannot report 307.51 if the diagnosis is anorexia nervosa (307.1), anorexia of unspecified cause (783.0), overeating of unspecified cause (783.6), vomiting NOS (787.03), cyclical vomiting (536.2), cyclical vomiting associated with migraine (346.2x) or psychogenic cyclical vomiting (306.4).

ICD-10: When you begin using ICD-10 codes, a bulimia nervosa diagnosis will crosswalk from 307.51 to F50.2 (Bulimia nervosa). You will also report F50.2 if you make a diagnosis of bulimia NOS or hyperorexia nervosa.

However, you cannot report F50.2 if you make a diagnosis of anorexia nervosa of binge eating or purging type.

Focus on These Basics Briefly

Documentation spotlight: The pediatrician will arrive at a diagnosis of bulimia nervosa based on a complete history and an evaluation of the person’s signs and symptoms; the encounter will include a complete mental status examination, a complete psychiatric and medical history of the patient and family, and a review of systems, along with ordering and interpreting diagnostic tests.

Some of the symptoms that the clinician might note in the documentation will include lightheadedness, dizziness, palpitations, soreness of throat (due to purging), abdominal pain, bloating, dysphagia, flatulence, constipation, and amenorrhea.

Upon examination of the patient, the pediatrician might note dry skin, nail damage, hair loss, edema, obesity, enlargement of parotids, hypotension, bradycardia, or tachycardia. Some of the lab tests that the clinician is likely to order if he suspects bulimia nervosa will include a CBC, amylase levels, blood chemistry to check for metabolic disturbances, and urinalysis to check hydration and to look for substance abuse.

If the pediatrician suspects bulimia nervosa, he might also ask for an ECG to rule out cardiovascular complications. The pediatrician will also assess the patient for other co-morbidities such as anxiety, depression, impulse disorders, and ADHD.

The pediatrician may also ask the patient to fill out assessment questionnaires, such as the SCOFF mnemonic questionnaire, eating disorder for primary care (ESP) questionnaire, and the eating attitude test (EAT) to help arrive at a diagnosis of bulimia nervosa.

Follow These Changes to Anorexia Nervosa

Reporting anorexia nervosa under ICD-10 requires you to look for specifics on whether the disease type is restricting or purging. Rely on the advice below to guide you to the right codes when ICD-10 comes into effect.

Pinpoint Weight Loss Reason in ICD-9

If you are using ICD-9-CM codes to report a diagnosis of anorexia nervosa, you will have to report it with 307.1 (Anorexia nervosa). But it is essential to note that this code cannot be used to report loss of appetite (783.0, Anorexia), weight loss due to feeding problems (783.3, Feeding difficulties and mismanagement) or any other unspecified eating disorder (307.50, Eating disorder, unspecified). In ICD-9-CM, you have to report anorexia nervosa with 307.1, irrespective of the type of the condition that the person is suffering from.

Look for Anorexia Type in ICD-10

When ICD-10 comes into effect, you will have to report anorexia nervosa using one of three codes under F50.0 (Anorexia nervosa). But as in ICD-9, you cannot report conditions like loss of appetite (R63.0, Anorexia) and a psychogenic loss of appetite (F50.8, Other eating disorders) using this code. F50.0 expands to three other codes depending on the type of anorexia nervosa using a fifth digit expansion.

So if the patient is suffering from a restricting type of anorexia nervosa, you report the condition with F50.01 (Anorexia nervosa, restricting type), and you report F50.02 (Anorexia nervosa, binge eating/purging type) if the person is suffering from a purging type of anorexia nervosa. However, if the type of anorexia is not specified, you will turn to F50.00 (Anorexia nervosa, unspecified).

The most common signs and symptoms of anorexia nervosa that you will see include appearance of severe malnutrition and weight loss. You might see details such as the person being excessively conscious about calorie intake, undertaking strict diets despite being underweight and thin, constant thoughts about food and cooking although he/she resorts to eating in very limited quantities (much less than normal) and the feeling of being overweight although the person is severely underweight.

The pediatrician will usually ask for tests such as complete blood count (CBC) to assess malnutrition, glucose tolerance test to assess other conditions such as diabetes, liver function and blood urea nitrogen tests to assess for malnutrition, urinalysis to check for substance abuse, etc. These tests are conducted to rule out other conditions that might be causing the problem or to ascertain the reasons for the condition. These tests will also help the pediatrician in assessing how the condition is affecting other major organ systems that might need treatment during management of the patient.

Coder Tips: Before ICD-10 approaches, be sure and replace the instances of 307.x with the F50 series to streamline your coding conversion.