Anorexia Nervosa, Bulimia, Gall Bladder Disease, Irritable Bowel Syndrome and Eating Disorders Help by Dr. W.P. Smedley M.D. F.A.C.S.

Financial Considerations

Since the advent of the Health Maintenance Organizations (HMO's) there has been a concentrated effort by the insurance companies to reduce or eliminate payments for psychiatric illnesses. This action has been followed by private insurance companies, including the Blues, to at least limit the number and duration of treatments and as a result of this to limit the payments thereof. Greater emphasis is now being placed on out-patient therapy whenever or wherever possible.

The diagnosis of anorexia and/or bulimia is a psychiatric diagnosis that is made "after no medical cause is found to account for the disease". This is stated in the DSM III, a book that lists the causes of psychiatric disorders. However, there may well be a medical cause for the signs and symptoms of anorexia/bulimia as described in the book "Mom, do I look fat?".

Once the diagnosis of anorexia/bulimia is made the patient is forever labeled as having a psychiatric illness, and from that time on, is viewed and treated differently by the insurance companies than those who have an organic or physical cause for their disease.

Therefore, because of this effort by the insurance companies to reduce their financial obligations to the patient and their families, it behooves each and every parent to make every effort to establish a medical diagnosis for their child before a psychiatric diagnosis of anorexia/bulimia is made. This also includes those individuals who develop similar signs and symptoms after puberty. In all those cases where the usual medical diagnostic studies are reported as "normal" these studies cannot be considered complete until the CCK Stimulation Test, performed with the patient in the erect position, is completed.

If the CCK Stimulation Test is abnormal, the patient cannot be labeled as having a psychiatric illness, and thereby no longer falls under the reduced payment guidelines of the insurance companies. Even if the CCK Stimulation Test has to be paid for "out of pocket" the future financial savings to the patient and family will be of great significance when this test is positive.

All illnesses are now classified by the insurance companies according to number codes. These number codes are known as ICD-9 codes. When a patient is discharged from the hospital their diagnoses are "coded" according to these number codes. These codes are used to identify and justify the need for hospitalization. The ICD-9 code for anorexia nervosa is 307.1.

If an individual suffers from severe effects of a digestive problem and needs hospitalization and no positive physical cause can be found at the time for the problem there is a tendency to label the patient as an anorexic/bulimic. However, there are other diagnostic codes (ICD-9 codes) which can be listed on that hospital discharge form by the physician to justify the admission other than anorexia, (307.1).

Remember, a diagnosis of anorexia nervosa (307.1) is one that can be made "only after no medical illness can be found to account for the disease". But until such time that the erect CCK Stimulation Test can be obtained the following ICD-9 codes can be used on the discharge to justify the hospital admission.

Electrolyte imbalance 276.9
Hyponatremia (low sodium level) 276.1
Severe weight loss 783.2
Dehydration 276.5
Hypotassemia (low potassium level) 276.8
Cachexia (extreme weight loss) 799.4
Malnutrition (mild, moderate, or severe) 261.0
Anorexia (loss of appetite) not specified as anorexia nervosa (738.0) The ICD-9 code 307.1 for anorexia nervosa should never be used on the discharge form at that hospital admission without the patient having an erect CCK Stimulation Test performed. Because, without that particular test, the patient is labeled forever as having a psychological cause for their digestive symptoms which will influence their health coverage from that time on.

Another very important consideration in your being labeled an anorexic/bulimic is that the diagnosis becomes an integral part of your past medical history. Whenever one is hospitalized the hospital record becomes a permanent part of your record which follows you throughout your lifetime. Your past medical history is important in future job applications, consideration in admissions to graduate and professional schools, and to employment in a government position. And you should be aware that a background check is always conducted for a security clearance. Anorexia (ICD Code 783.0) means a loss of appetite and this code means that it can be due to many other causes other than anorexia nervosa (307.1) but anorexia nervosa (307.1) is a psychiatric diagnosis, meaning that there is a mental illness as its cause. Why then, with all these important, future and lifetime considerations, should you be denied the opportunity to undergo an inexpensive and relatively simple diagnostic test, the erect CCK, to demonstrate that the disease could have a medical cause and not a psychological one?