Eating Disorder Treatment Plan and Note Writing Tips

To satisfy insurers and audits, your eating disorder treatment plan should include diagnosis-linked, measurable goals with timeframes and objective ways to track progress. Medicare-oriented guidance commonly emphasizes that a treatment plan should be consistent with the diagnosis and include objective, measurable goals and a timeframe.

Level of care decisions should be guided by standardized criteria such as the American Society of Addiction Medicine (ASAM) dimensions adapted for eating disorders or APA practice guidelines. Consider six key dimensions: medical stability (vital signs, labs, cardiac function), suicide risk and psychiatric comorbidity, substance use complications, motivation and readiness to change, relapse potential, and recovery environment support.

• Inpatient hospitalization is indicated for medical instability including severe bradycardia (heart rate below 40 bpm), hypotension, electrolyte imbalances, severe malnutrition (BMI below 15 or rapid weight loss), uncontrolled purging, or acute suicidality.
• Residential treatment (24-hour care) suits patients who are medically stable but require intensive structure, have failed at lower levels, or lack environmental support.
• Partial hospitalization (PHP) provides 6+ hours daily of programming for patients needing intensive intervention but who can sleep at home safely.
• Intensive outpatient (IOP) involves 9-12 hours weekly for those with moderate symptoms and some stability.
• Outpatient care is appropriate for motivated patients with medical stability, supportive environments, and mild-to-moderate symptoms.

Document your rationale using measurable criteria: specific vital signs, weight parameters, psychiatric symptoms scores, prior treatment response, and family/environmental factors. Reassess level of care weekly in intensive settings and monthly in outpatient care, adjusting based on progress toward treatment goals.

Your treatment plan must contain specific elements to satisfy payer requirements: a diagnostic assessment with ICD-10 codes (F50.0x for anorexia nervosa, F50.2 for bulimia nervosa, F50.8x for binge eating disorder, etc.), measurable goals with target dates, specific interventions with frequency and duration, provider credentials and service codes, and medical necessity justification.

For CPT coding, use appropriate codes: 90791 for diagnostic assessment, 90832-90837 for individual psychotherapy (time-based), 90846-90847 for family therapy, 90853 for group therapy, 97803-97804 for medical nutrition therapy by registered dietitians, and 99202-99215 for evaluation and management services. Document time spent and specific interventions delivered for each session.

Medicare and commercial insurers require that treatment plans demonstrate medical necessity, include objective measures of progress (weight, vital signs, symptom scales), show multidisciplinary coordination, and be updated at required intervals (typically every 30-90 days). Include measurable outcome criteria such as target weight ranges, meal completion percentages, reduction in compensatory behaviors (frequency counts), and standardized assessment scores like the Eating Disorder Examination Questionnaire (EDE-Q) or Clinical Impairment Assessment (CIA).

Keep contemporaneous progress notes that link to treatment plan goals, document any changes in level of care or treatment intensity, and ensure all providers sign and date the plan. For higher levels of care, obtain prior authorization and provide supporting clinical documentation including recent vitals, labs, weight history, and failure at lower levels of care when applicable.

Begin by designating a care coordinator (often the primary therapist or case manager) who facilitates communication across the team. Schedule regular multidisciplinary case conferences (weekly for intensive levels of care, monthly for outpatient) where all providers review progress, adjust interventions, and ensure consistent messaging to the patient and family.

In your written treatment plan, assign specific roles and responsibilities to each discipline. The registered dietitian should conduct nutritional assessment, create individualized meal plans with caloric targets, provide nutrition counseling (frequency specified), monitor meal completion and dietary variety, and educate about hunger/fullness cues. The primary care physician or medical provider monitors vital signs (frequency specified, e.g., weekly), orders and interprets laboratory work (CBC, CMP, magnesium, phosphorus, EKG as indicated), manages medical complications, prescribes medications, and provides medical clearance for physical activity.

The psychiatrist evaluates and treats co-occurring mental health conditions, prescribes psychotropic medications (document rationale, target symptoms, monitoring plan), assesses risk, and provides medication management sessions at specified intervals. The psychotherapist delivers evidence-based psychotherapy (specify modality and frequency), addresses underlying psychological factors, teaches coping skills, and monitors behavioral symptoms. Family members participate in family-based treatment (if appropriate), attend psychoeducation sessions, provide home environment support, and engage in family therapy (frequency specified).

Document how information will be shared across providers (releases of information, shared electronic health records, regular reports), establish communication protocols for urgent concerns, and create a single integrated treatment plan document that all team members reference and contribute to. Include specific handoff procedures when patients transition between levels of care or providers.

Define step-down criteria with objective, measurable parameters. For transitions from inpatient to residential: medical stabilization (vital signs within safe parameters for age for at least 48-72 hours), electrolytes normalized, ability to participate in programming, reduced acute psychiatric risk. From residential to partial hospitalization: demonstrated weight stability or consistent gains, meal completion above specified threshold (e.g., 80-90%), reduction in compensatory behaviors, engagement in therapeutic process. From PHP to IOP: sustained medical stability, independence with meals, symptom management skills demonstrated, reduced symptom frequency. From IOP to outpatient: consistent symptom reduction, established coping strategies, stable weight, family/environmental support in place.

Similarly, document step-up criteria: when to intensify care based on medical instability, weight loss or inadequate gain despite treatment, increased symptom frequency, worsening psychiatric symptoms, safety concerns, or treatment non-adherence. Include specific parameters (e.g., "if weight decreases by more than 2 lbs per week on two consecutive weeks, consider PHP") so decisions are data-driven rather than subjective.

Relapse prevention planning should be integrated throughout treatment, not just at discharge. Include: identifying early warning signs specific to the individual (behavioral, cognitive, emotional, physical), creating a written list of coping strategies and supports to use when warning signs emerge, establishing a monitoring plan post-discharge (weigh-ins, check-ins with providers), scheduling follow-up appointments before discharge, and identifying support persons who can help identify relapse signs.

Develop a detailed aftercare plan that specifies: ongoing outpatient therapy (frequency and duration), medication management schedule, dietitian follow-up, primary care monitoring (frequency of weigh-ins, lab work schedule), support groups or peer support participation, and vocational/educational reintegration plans. Ensure continuity by having discharge summaries sent to outpatient providers before the first appointment, offering transition sessions with new providers, and maintaining contact during the transition period.

Create a crisis plan that patients and families can reference, including: specific warning signs requiring immediate attention (suicidal ideation, severe restriction, syncope, chest pain, etc.), emergency contact numbers (therapist, psychiatrist, crisis line, emergency department), decision tree for when to contact each resource, and coping strategies to use in crisis moments. Document that this plan was reviewed with patient and family and that they have a copy.

Best practices for involving family and carers in eating disorder treatment planning vary by developmental stage but should always be clearly documented in the treatment plan.

Children and adolescents:
Family involvement is essential, and family-based treatment (FBT) is the evidence-based standard when appropriate. Treatment plans should specify that parents supervise meals and snacks, make decisions about eating and activity, and participate in therapy sessions. Document FBT phases and the family’s role at each stage. When FBT is not appropriate (e.g., significant family conflict, safety concerns, or older adolescents seeking autonomy), incorporate family psychoeducation and periodic check-ins alongside individual therapy.

Consent and confidentiality:
For minors, parents provide consent, but clinicians should include age-appropriate discussions with adolescents about goals and plans. Clearly document confidentiality boundaries, balancing adolescent privacy with parental need for information—particularly when medical or safety risks are present.

Young adults:
For late adolescents and young adults, assess developmental stage and autonomy. With the patient’s consent and appropriate releases, many benefit from family involvement through psychoeducation, meal support coaching, and periodic family sessions. Document the agreed-upon level of family participation.

Adults:
Family or partner involvement should be offered collaboratively and documented based on patient preference. When included, supports may participate in psychoeducation, learn communication and support skills, attend family sessions, and assist with practical meal or recovery support.

Carers across the lifespan:
Offer carer-focused education or skills training (e.g., communication skills, reducing accommodation, managing stress). Carer support can be included in the treatment plan even if carers are not present in therapy sessions.

Across all ages:
Address confidentiality explicitly, obtain appropriate releases of information, and document what will be shared and when. Consider cultural factors that may influence family roles, communication, and treatment engagement. The treatment plan should clearly document who is involved, their roles, session frequency, goals for family work, and how progress will be measured. If family is not involved, document the rationale and how this will be addressed clinically.