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For other articles and previous issues click here. November 1, 2004 Coding
for Eating Disorders Eating disorders are characterized by a preoccupation with weight that results in severe disturbances in eating behaviors. The three main types of eating disorders are anorexia nervosa, bulimia, and binge eating. Other variations of eating disorders include purging without binging, chewing and spitting without purging, and anorexic behavior with less severe weight loss. Anorexia Nervosa Signs and symptoms of anorexia nervosa include the following: • Restricts foods or types of food • Induces weight loss by vomiting, abuse of laxatives, use of diuretics or enemas, or excessive exercise • Intense fear of gaining weight • Sees body as overweight in spite of being underweight • Abnormal menstrual cycle in females • Secrecy about food and denial of an eating problem • Fatigue • Depression • Irregular heart rate • Lightheadedness • Anemia • Brittle hair and nails • Skeletal muscle atrophy Malnutrition is integral to anorexia nervosa. When a patient is admitted with malnutrition and anorexia nervosa, sequence code 307.1 as the principal diagnosis with no additional code for the malnutrition (AHA Coding Clinic for ICD-9-CM, 1989, fourth quarter, page 11). Bulimia Signs and symptoms of bulimia include the following: • Eating more food in a binge episode than normal • Purging after eating — not all people purge by inducing vomiting. Purging may include abuse of laxatives, diuretics, or enemas; excessive exercise; or fasting • Feelings of loss of control during binge • Feelings of shame, guilt, and intense fear of gaining weight after binging episode • Unhealthy focus on body shape and weight • Dehydration • Fatigue • Weakness • Depression • Irritability • Dry, yellow skin • Damaged teeth and gums from gastric acid • Swollen cheeks • Irregular heart rate Binge Eating Disorder Signs and symptoms of binge eating disorder include the following: • Episodes of compulsive overeating not followed by purging • Steady weight gain • Eating when not hungry or until uncomfortably full • Eating alone • Fatigue • Joint pain • Gallbladder disease • Hypertension • Hypercholesterolemia Diagnosis • Complete blood count to determine whether or not the patient has anemia • Electrocardiogram to show whether or not the patient has irregular heart rhythms • Chest x-ray to detect damaged heart muscles • Computed tomography scan to determine whether or not there is damage to brain or digestive tract • Bone density test The physician may also perform a body mass index in possible anorexic cases to determine if the patient is underweight. Treatment • Nutrition education • Psychotherapy • Family counseling • Medications to assist with depression and anxiety In anorexia nervosa, the patient may need to be hospitalized to treat dehydration, malnutrition, and electrolyte disorders. The patient needs to gradually restore normal body weight and eating habits. Coding and sequencing for eating disorders are dependent upon the physician documentation in the medical record and application of the Official Coding Guidelines for inpatient care. Also, use specific AHA Coding Clinic for ICD-9-CM and American Medical Association CPT Assistant references to ensure complete and accurate coding. — This information was prepared by Audrey Howard, RHIA, and Vicki Sippel, RHIA, of 3M Health Information Systems (800-367-2447), a leading supplier of coding and classification systems to nearly 4,000 healthcare providers. The company and its representatives do not assume any responsibility for reimbursement decisions or claims denials made by providers or payors as the result of the misuse of this coding information. |
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