F50.2 — Bulimia Nervosa

Clinical Description

F50.2 codes bulimia nervosa, characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors (purging, laxative use, fasting, excessive exercise). Documentation should capture binge-purge frequency, medical risks, and self-evaluation tied to body shape and weight.

Key Symptoms to Document

When using F50.2, your documentation should reference these symptoms:

• Recurrent episodes of binge eating (large amounts in a discrete period with loss of control)
• Recurrent compensatory behaviors to prevent weight gain (self-induced vomiting, laxatives, diuretics, fasting, excessive exercise)
• Self-evaluation unduly influenced by body shape and weight
• Binge eating and compensatory behaviors occurring at least once per week for 3 months
• Shame or distress related to binge-eating episodes
• Dental erosion, parotid gland swelling, or Russell's sign (knuckle calluses)

Common Interventions to Document

Evidence-based interventions typically documented with this diagnosis:

• CBT-E (Enhanced Cognitive Behavioral Therapy for eating disorders)
• SSRI pharmacotherapy (fluoxetine 60mg — FDA-approved for bulimia)
• Interpersonal Therapy (IPT)
• Dialectical Behavior Therapy (DBT) skills for emotion regulation
• Nutritional counseling to establish regular eating patterns

CPT Code Pairings

Common CPT codes used when billing with F50.2:

• 90791 — Psychiatric diagnostic evaluation
• 90837 — Individual psychotherapy, 60 minutes
• 90834 — Individual psychotherapy, 45 minutes
• 99214 — Office visit, moderate complexity (medical monitoring)
• 90853 — Group psychotherapy

Documentation Tips

• Document binge-purge frequency to establish severity: mild (1-3/week), moderate (4-7/week), severe (8-13/week), extreme (14+/week).
• Record specific compensatory behaviors used (vomiting, laxatives, diuretics, fasting, exercise).
• Document medical complications: electrolyte abnormalities (hypokalemia), metabolic alkalosis, dental erosion, esophageal tears.
• Note that body weight may be normal or above normal — bulimia does not require low body weight (unlike anorexia).
• Assess and document co-occurring conditions: depression, substance use, self-harm behaviors.

Differential Diagnosis Considerations

When documenting F50.2, consider and rule out:

• Anorexia nervosa, binge-eating/purging type (F50.02)
• Binge eating disorder (F50.81)
• Major depressive disorder with appetite changes (F32.x)
• Borderline personality disorder (F60.3)
• Kleine-Levin syndrome

Screening Tools

Standardized measures commonly used with this diagnosis:

• EDE-Q (Eating Disorder Examination Questionnaire)
• BULIT-R (Bulimia Test — Revised)
• SCOFF Questionnaire
• EAT-26 (Eating Attitudes Test)
• CIA (Clinical Impairment Assessment)