Quick reference
- When to use
- Use F50.2 when the client meets full criteria for Bulimia Nervosa. Specify severity level per DSM-5 guidelines. For anorexia, base severity on BMI. For bulimia/BED, base on frequency of compensatory behaviors or binge episodes.
- Duration
- Anorexia: ongoing until remission criteria met. Bulimia/BED: behaviors must occur at least weekly for 3 months. Partial remission: previously met full criteria, some symptoms persist. Full remission: no criteria met for sustained period.
- Session codes
- Pair with CPT 90837 (60-min, often needed for meal planning + therapy). 90834 for maintenance. 96127 for EDE-Q screening. Medical monitoring may require coordination with primary care. FBT: 90847.
- Key indicators
- Restriction, bingeing, or purging behaviors • Body image disturbance • Weight/shape overvaluation • Medical complications • Functional impairment • Specific BMI or behavior frequency thresholds
What F50.2 represents
Bulimia Nervosa involves recurrent episodes of binge eating followed by inappropriate compensatory behaviors such as self-induced vomiting, misuse of laxatives, fasting, or excessive exercise. Unlike anorexia, individuals with BN are typically at or above normal weight.
Key diagnostic criteria
- Recurrent episodes of binge eating (eating a large amount in a discrete time period with loss of control)
- Recurrent compensatory behaviors
- Both occur at least once a week for 3 months
- Self-evaluation unduly influenced by body shape/weight
- Does not occur exclusively during anorexia nervosa episodes
Specify severity based on frequency of compensatory behaviors
Documentation essentials
Document binge and purge frequency, methods, duration, and physical consequences. Monitor dental health, electrolytes.
Differential diagnosis
Distinguish from anorexia nervosa binge-eating/purging type, binge eating disorder, and Kleine-Levin syndrome.
Treatment planning
CBT-E (enhanced CBT), IPT, guided self-help, fluoxetine (FDA-approved for BN). Nutritional counseling.
Insurance & billing
Well-accepted. Document frequency of behaviors and medical complications.
Updates & changes
DSM-5 reduced frequency threshold from twice to once weekly.
Documentation pitfalls
Don't overlook medical complications. Document compensatory behavior type and frequency.
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).