I'd code them separately - Gastroparesis can also be caused by diabetes, so the etiology of Anorexia should be primary. I wouldn't read too much into the "and" - I think the doctor's just saying that the patient has both. I would think the order of the conditions says something, though. The doctor listing Anorexia first tells me that he considers it the main issue. I might be wrong about that, though - a good way to check is to see if the note indicates anorexia, or anorexia nervosa. If it is anorexia nervosa, then it's a safe bet that it's the etiology, not the manifestation. If not, then you'll have to rely on the body of the note to give you context clues as to whether the chicken or the egg came first.
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