Rumination-Regurgitation Disorder (ICD-11: 6B85): Complete Coding and Diagnostic Guide

1. Introduction

Rumination-regurgitation disorder represents a complex and frequently underdiagnosed eating condition, characterized by intentional and repeated regurgitation of previously swallowed food. Unlike vomiting, this behavior is voluntary and may include rechewing and reswallowing of the regurgitated content, or its deliberate expulsion. This condition affects individuals across various age groups, from young children to adults, and can cause significant impact on quality of life, nutritional status, and social functioning.

The clinical importance of rumination-regurgitation disorder lies not only in its direct consequences to physical health, such as malnutrition, weight loss, electrolyte imbalances, and dental problems, but also in its psychosocial impact. Patients frequently experience social embarrassment, isolation, and difficulties in situations involving shared meals. Despite its clinical relevance, this disorder often remains unrecognized or is incorrectly diagnosed as gastroesophageal reflux, bulimia nervosa, or other gastrointestinal conditions.

Correct coding using the ICD-11 code 6B85 is critical for various aspects of healthcare. It enables appropriate epidemiological tracking, facilitates communication among healthcare professionals, ensures appropriate access to specialized treatments, and guarantees accurate documentation for administrative and research purposes. The transition from ICD-10 to ICD-11 brought greater diagnostic clarity and specificity in the classification of eating disorders, making it essential that healthcare professionals fully understand the criteria and correct application of this code.

2. Correct ICD-11 Code

Code: 6B85

Description: Rumination-regurgitation disorder

Parent category: Feeding or eating disorders

Complete official definition: Rumination-regurgitation disorder is characterized by bringing back into the mouth food that has been previously swallowed (i.e., regurgitation), in an intentional and repeated manner, which may be chewed and swallowed again (i.e., rumination), or may be deliberately spat out (but not as occurs with vomiting). The regurgitation behavior is frequent (at least several times per week) and sustained over a period of at least several weeks. The regurgitation behavior is not fully explained by another medical condition that directly causes regurgitation (e.g., esophageal stenosis or neuromuscular disorders affecting esophageal functioning) or that causes nausea or vomiting (e.g., pyloric stenosis).

Age criterion: Rumination-regurgitation disorder should only be diagnosed in individuals who have reached a developmental age of at least 2 years. This criterion is fundamental to differentiate pathological behavior from normal regurgitation observed in infants.

The classification within feeding or eating disorders reflects the behavioral and psychological nature of this condition, distinguishing it from purely organic causes of regurgitation. This categorization facilitates appropriate direction toward specialized mental health and behavioral treatments.

3. When to Use This Code

The code 6B85 should be applied in specific clinical situations where all diagnostic criteria are present. Below, we present detailed practical scenarios:

Scenario 1: School-age child with established rumination behavior A 6-year-old child is brought to the clinic with a report of frequent regurgitation after meals, occurring daily for approximately 4 months. Clinical observation and caregiver reports reveal that the child deliberately brings food back into the mouth, chews it again, and reswallows. There is no associated nausea, the behavior occurs in situations of stress or boredom, and gastrointestinal investigations have excluded organic causes. This is a typical case for coding 6B85.

Scenario 2: Adolescent with rumination without other eating disorders A 14-year-old adolescent presents with a 6-month history of intentional regurgitation multiple times per week, particularly after main meals. The patient describes the process as automatic but controllable, without concerns related to body weight, without compensatory behaviors typical of bulimia, and without significant food restriction. Endoscopic evaluation ruled out achalasia or other structural conditions. The code 6B85 is appropriate when rumination behavior is the predominant feature.

Scenario 3: Young adult with long-standing rumination A 23-year-old patient reports regurgitation behavior since adolescence, occurring several times a day, especially in stressful social contexts. The patient describes deliberately bringing food back, chewing and reswallowing, experiencing temporary relief from anxiety. There is no evidence of gastroesophageal reflux disease, gastroparesis, or other esophageal motility disorders after complete investigation. The chronic pattern and absence of organic causes justify the code 6B85.

Scenario 4: Patient with intellectual disability and behavioral rumination An 18-year-old patient with moderate intellectual disability presents with repetitive behavior of regurgitation and rechewing of food, consistently observed for more than one year. The behavior occurs regardless of food type and appears to have a self-regulatory function. Medical evaluations have excluded structural gastrointestinal causes. In patients with developmental disabilities, the code 6B85 is appropriate when the behavior meets the criteria for frequency and duration.

Scenario 5: Child with post-trauma rumination An 8-year-old child developed rumination behavior following prolonged hospitalization, manifesting intentional regurgitation multiple times daily for 3 months. The behavior initially began as a response to food discomfort but became an established pattern. Investigations have excluded dysphagia, stenosis, or other medical complications. The code 6B85 is applicable regardless of the initial precipitating factor, as long as the behavior becomes established as a sustained pattern.

Scenario 6: Patient with rumination and nutritional impact A 16-year-old patient presents with unintentional weight loss associated with frequent rumination behavior (10-15 times per week) for 5 months. Approximately 30-40% of regurgitated food is spit out rather than reswallowed, resulting in caloric deficit. There is no fear of weight gain, body image distortion, or other symptoms of anorexia or bulimia nervosa. The code 6B85 remains appropriate when weight loss is a consequence of rumination behavior, not the primary objective.

4. When NOT to Use This Code

Incorrect application of code 6B85 can occur when conditions similar to or related to rumination-regurgitation disorder are confused with the disorder. It is fundamental to recognize exclusion situations:

Exclusion for organic gastrointestinal conditions: When regurgitation is caused by structural or functional medical conditions such as esophageal stenosis, achalasia, scleroderma with esophageal involvement, gastroparesis, or neuromuscular disorders affecting esophageal function, code 6B85 should not be used. In these cases, coding should reflect the underlying medical condition. Differentiation requires appropriate gastrointestinal investigation including endoscopy, manometry, or motility studies when clinically indicated.

Exclusion for nausea and vomiting: If the patient presents with nausea or vomiting as code 677319549, rather than intentional regurgitation, code 6B85 is not appropriate. Vomiting is an involuntary process preceded by nausea, involving abdominal contractions and forceful expulsion of gastric contents, differing from the voluntary regurgitation characteristic of rumination. Conditions such as pyloric stenosis, gastritis, or other causes of vomiting should be coded separately.

Exclusion for adult rumination syndrome: Although controversial, if the local coding system specifies adult rumination syndrome with separate code 55732315, that specification should be followed. Some systems classify rumination in adults separately due to differences in clinical context and therapeutic approach.

Exclusion for bulimia nervosa: When regurgitation/vomiting behavior is associated with intense concerns about weight and body shape, episodes of binge eating, and regular compensatory behaviors, the appropriate diagnosis is bulimia nervosa (6B81), not rumination-regurgitation disorder. The fundamental distinction is the presence of psychopathology related to weight and body shape in bulimia.

Exclusion for infants under 2 years of age: Regurgitation in infants and children under 2 years of developmental age should not be coded as 6B85, even if frequent, as it represents a common developmental phenomenon. Only after 2 years of developmental age is the diagnosis of rumination-regurgitation disorder appropriate.

5. Step-by-Step Coding Process

Step 1: Assess diagnostic criteria

Confirmation of the diagnosis of rumination-regurgitation disorder requires systematic evaluation of multiple criteria. Initially, establish the presence of repeated regurgitation of previously swallowed food, clearly differentiating from vomiting. Specifically inquire about the intentionality of the behavior, frequency (must occur at least several times per week), and duration (sustained for at least several weeks).

Clinical evaluation should include detailed interview about eating patterns, direct observation when possible, and collection of information from family members or caregivers. Assessment instruments such as detailed food diaries documenting regurgitation episodes, precipitating contexts, and fate of regurgitated food (rechewed/reswallowed versus spit out) provide essential objective data.

Medical investigation to exclude organic causes is a critical component of the evaluation. Depending on clinical presentation, it may include upper gastrointestinal endoscopy, gastric emptying studies, esophageal manometry, or imaging studies. The absence of findings that completely explain the regurgitation is necessary for the diagnosis of rumination-regurgitation disorder.

Step 2: Verify specifiers

Although code 6B85 does not have formally specified subtypes in ICD-11, clinical documentation should characterize important aspects of the disorder. Record the specific frequency of episodes (number per day or week), total duration of the disorder, and proportion of regurgitated food that is reswallowed versus spit out.

Assess and document severity considering nutritional impact (weight loss, nutritional deficiencies), functional impairment (interference with social, school, or occupational activities), and medical complications (dental erosion, esophagitis, electrolyte imbalances). This information, although it does not change the primary code, is essential for treatment planning and monitoring.

Identify contextual factors associated with rumination episodes, such as situations of stress, boredom, or specific emotional states. In patients with developmental disabilities, characterize the behavioral function of rumination (sensory self-regulation, attention-seeking, etc.).

Step 3: Differentiate from other codes

Differentiation from 6B80 (Anorexia nervosa): Anorexia nervosa is fundamentally characterized by intentional food restriction leading to significantly low body weight, intense fear of weight gain, and disturbance in the experience of weight or body shape. In rumination-regurgitation disorder, there is not necessarily intentional food restriction or weight-related concerns. Patients with rumination may have normal or even above-normal weight, and regurgitation is not motivated by weight control. If both conditions coexist and fully meet diagnostic criteria, both codes may be applied.

Differentiation from 6B81 (Bulimia nervosa): Bulimia nervosa involves recurrent episodes of binge eating followed by inappropriate compensatory behaviors (self-induced vomiting, laxative use, excessive exercise), with self-evaluation unduly influenced by weight and body shape. Vomiting in bulimia is typically secretive, associated with shame, and occurs following binge episodes. In rumination, regurgitation may occur after normal meals, not necessarily after binge eating, and there is not necessarily the central psychopathology related to weight present in bulimia. Regurgitation in rumination also tends to be less forced and more "automatic" than self-induced vomiting.

Differentiation from 6B82 (Binge eating disorder): Binge eating disorder is characterized by recurrent episodes of binge eating (consumption of an amount of food definitely larger than most people would consume in a similar period, with a sense of loss of control) without regular compensatory behaviors. There is no characteristic regurgitation. If a patient presents with both binge eating and rumination, and both meet the criteria for frequency and duration, dual coding may be considered, although this combination is uncommon.

Step 4: Required documentation

Adequate documentation to support code 6B85 should include:

Checklist of mandatory information:

• Detailed description of regurgitation behavior (how it occurs, intentionality)
• Specific frequency (number of episodes per day/week)
• Total duration of the disorder (approximate date of onset)
• Proportion of regurgitated food that is rechewed/reswallowed versus spit out
• Patient's age (confirming developmental age ≥ 2 years)
• Results of investigations that exclude organic causes
• Absence of nausea preceding regurgitation
• Nutritional impact and effect on body weight
• Functional impairment (social, school, occupational)
• Precipitating or contextual factors identified
• Psychiatric or medical comorbidities
• Previous treatments and responses

Appropriate recording format: Documentation should clearly establish that the diagnosis of rumination-regurgitation disorder was considered after comprehensive evaluation, differentiation from alternative diagnoses, and exclusion of organic medical causes. Specifically record: "Rumination-regurgitation disorder (ICD-11: 6B85) characterized by [specific description of behavior], occurring [frequency] for [duration]. Organic causes excluded by [investigations performed]. Complete diagnostic criteria met."

6. Complete Practical Example

Clinical Case:

A 12-year-old female patient is referred to the mental health service by a pediatrician due to unusual eating behavior and weight loss of 4 kg over the past 5 months. The mother reports that approximately 7 months ago the patient began experiencing frequent episodes of "regurgitation" after meals. Initially, the family thought it was gastroesophageal reflux, but they observed that the behavior seemed intentional.

During the clinical interview, the patient describes that after eating, she can bring the food back to her mouth "without effort," different from vomiting. She reports that she chews the food again and, most of the time, swallows it again, but occasionally (about 30% of the time) she discreetly spits it into a napkin or in the bathroom. This behavior occurs approximately 8-12 times per week, mainly after lunch and dinner, but also occasionally after snacks.

The patient denies nausea before regurgitation and describes the process as "almost automatic," although she admits that she can control it if she is very focused on not doing it. She reports that the behavior initially started after an episode of acute gastroenteritis 7 months ago, but continued even after complete resolution of the illness. She denies excessive concerns about weight or body shape, does not present episodes of binge eating, and does not engage in other compensatory behaviors such as excessive exercise or laxative use.

Previous medical evaluation included upper gastrointestinal endoscopy (normal), abdominal ultrasound (normal), and basic laboratory tests (within normal limits except for mild hypoalbuminemia). The pediatrician ruled out structural or functional organic causes. The weight loss appears to be related to the fact that part of the food is spit out and not reswallowed.

The patient presents preserved school functioning, but reports avoiding social situations involving eating due to embarrassment. There is no history of other psychiatric disorders, although she reports mild anxiety in social situations. Development was typical, with no cognitive or neurodevelopmental deficiencies.

Step-by-Step Coding:

Criteria Analysis:

1. Repeated regurgitation of previously swallowed food: PRESENT (8-12 times/week)
2. Intentional or voluntary: PRESENT (patient describes control over the behavior)
3. Food may be rechewed and reswallowed: PRESENT (occurs in ~70% of episodes)
4. Or may be deliberately spit out: PRESENT (occurs in ~30% of episodes)
5. Frequency of at least several times per week: PRESENT (8-12 times/week)
6. Duration of at least several weeks: PRESENT (7 months)
7. Not explained by a medical condition causing regurgitation: CONFIRMED (normal investigations)
8. Not explained by a condition causing nausea/vomiting: CONFIRMED (no nausea, no vomiting)
9. Age of onset ≥ 2 years: PRESENT (12 years old)

Code chosen: 6B85 - Rumination-regurgitation disorder

Complete Justification: All diagnostic criteria for rumination-regurgitation disorder are present. The patient presents an established pattern of intentional and repeated regurgitation, with frequency and duration exceeding minimum criteria. Comprehensive medical investigation ruled out organic causes of regurgitation. The behavior is not better explained by another eating disorder: there is no intentional food restriction or fear of weight gain (excluding anorexia nervosa 6B80), no episodes of binge eating or self-induced vomiting after binge eating (excluding bulimia nervosa 6B81), and no episodes of binge eating (excluding binge eating disorder 6B82).

Complementary codes:

• Consider additional coding for mild social anxiety if clinically significant and meeting diagnostic criteria
• Code medical complications if present (malnutrition, electrolyte imbalances)

Suggested Documentation: "12-year-old female patient with diagnosis of Rumination-regurgitation disorder (ICD-11: 6B85). Presents with intentional regurgitation of food 8-12 times/week for 7 months, with rechewing and reswallowing in approximately 70% of episodes and deliberate expulsion in 30%. Absence of nausea preceding regurgitation. Organic causes ruled out by upper gastrointestinal endoscopy and complete pediatric evaluation. Weight loss of 4 kg in 5 months secondary to the behavior. Functional impairment in social situations involving eating. Absence of psychopathology related to weight/body shape. Complete diagnostic criteria met. Therapeutic plan includes behavioral psychotherapy and nutritional monitoring."

7. Related Codes and Differentiation

Within the Same Category:

6B80: Anorexia nervosa

• When to use 6B80: When there is intentional dietary restriction leading to significantly low weight, intense fear of weight gain, and disturbance in the perception of weight or body shape. The central focus is weight control through dietary restriction.
• When to use 6B85: When the central behavior is repeated regurgitation without necessarily intentional dietary restriction or pathological concerns about weight.
• Main difference: In anorexia, dietary restriction and fear of weight gain are central; in rumination, the behavior of regurgitating and rechewing is the defining characteristic, independent of weight concerns.

6B81: Bulimia nervosa

• When to use 6B81: When there are recurrent episodes of binge eating followed by compensatory behaviors (self-induced vomiting, laxatives, etc.), with self-evaluation unduly influenced by weight and shape.
• When to use 6B85: When there is regurgitation after normal meals (not necessarily after binge eating), without the central psychopathology related to weight characteristic of bulimia.
• Main difference: Bulimia involves binge eating and compensation motivated by weight concerns; rumination involves regurgitation that may occur independent of binge eating or weight-related motivation.

6B82: Binge eating disorder

• When to use 6B82: When there are recurrent episodes of binge eating (excessive consumption with loss of control) without regular compensatory behaviors.
• When to use 6B85: When the predominant behavior is regurgitation and rumination, not binge eating.
• Main difference: In binge eating disorder, the focus is on episodes of excessive consumption; in rumination, the focus is on the behavior of regurgitating and rechewing already consumed food.

Differential Diagnoses:

Gastroesophageal reflux disease (GERD): In GERD, regurgitation is involuntary, often associated with heartburn, and caused by lower esophageal sphincter dysfunction. Investigation with endoscopy and pH monitoring may be necessary for differentiation.

Gastroparesis: Characterized by delayed gastric emptying, can cause regurgitation, but is accompanied by nausea, vomiting, early satiety, and abdominal discomfort. Gastric emptying studies establish the diagnosis.

Achalasia: Esophageal motility disorder with failure of lower esophageal sphincter relaxation, causes regurgitation of undigested food, but is involuntary and accompanied by progressive dysphagia. Esophageal manometry is diagnostic.

8. Differences with ICD-10

In ICD-10, rumination disorder was coded as F98.2 (Feeding disorder of infancy and childhood - childhood rumination disorder), reflecting the historical conception that this condition primarily affected young children. This classification was limited and did not adequately capture cases in adolescents and adults.

ICD-11 introduces significant changes with code 6B85:

Main changes:

1. Recognition across all ages: ICD-11 explicitly recognizes that rumination-regurgitation disorder can occur at any age from 2 years of development onward, not only in childhood, removing the conceptual limitation of ICD-10.

2. Updated classification: The shift from category "F" (mental and behavioral disorders) to "6B" (feeding or eating disorders) reflects better understanding of the nature of the disorder and its relationship with other eating disorders.

3. More specific criteria: ICD-11 provides more detailed diagnostic criteria, including specifications about frequency (several times per week), duration (several weeks), and the need to exclude organic medical causes more explicitly.

4. Clear differentiation: ICD-11 establishes clearer differentiation between rumination-regurgitation disorder and other eating disorders, particularly bulimia nervosa, where regurgitation/vomiting may occur but in a different context.

Practical impact of these changes: The transition to ICD-11 allows for more appropriate identification and treatment of cases in adolescents and adults that previously could have been misclassified. The increased specificity of diagnostic criteria improves diagnostic consistency among different professionals and services. For research purposes, more precise coding facilitates epidemiological studies and treatment efficacy research. Healthcare systems and insurers can now appropriately recognize and process cases across all age groups, not only in young children.

9. Frequently Asked Questions

1. How is rumination-regurgitation disorder diagnosed?

The diagnosis is fundamentally clinical, based on detailed history and observation of behavior. The evaluation includes interview with the patient and, when appropriate, with family members or caregivers, to characterize the pattern of regurgitation, its frequency, duration, and associated contexts. It is essential to differentiate regurgitation from vomiting: regurgitation is typically effortless, not preceded by nausea, and the patient has control over the behavior. Medical investigations such as digestive endoscopy, esophageal motility studies, or gastric emptying studies may be necessary to exclude organic causes, but the diagnosis itself does not require specific findings on examination - in fact, the absence of organic explanation is part of the diagnostic criteria. Detailed food diaries documenting regurgitation episodes can provide valuable objective information.

2. Is treatment available in public health systems?

Treatment for rumination-regurgitation disorder is generally available in public health systems, although accessibility varies according to local resources. Primary treatment is psychotherapeutic, particularly cognitive-behavioral therapy and habit reversal training techniques, which can be offered in outpatient mental health services. In pediatric cases, psychology or child psychiatry services are appropriate. For cases with significant nutritional complications, nutritional monitoring may be necessary. Severe cases may require hospitalization for nutritional stabilization and intensive treatment. The availability of professionals specifically trained in eating disorders varies, but basic behavioral principles can be applied by generalist mental health professionals.

3. How long does treatment last?

Treatment duration varies considerably depending on the severity of the disorder, duration of symptoms before treatment, presence of comorbidities, and individual response to intervention. Structured behavioral treatments typically involve weekly sessions for an initial period of 8 to 16 weeks, with possible extension if necessary. Some patients respond relatively quickly, with significant reduction in rumination episodes within a few weeks, while others require more prolonged treatment. After the initial intensive phase, less frequent maintenance sessions may be necessary to prevent relapse. In chronic cases or those with significant complications, treatment may extend for several months to a year or more. Long-term monitoring is often recommended even after symptom resolution.

4. Can this code be used on medical certificates?

Yes, code 6B85 can and should be used on medical certificates when clinically appropriate and necessary to justify absence from activities. Rumination-regurgitation disorder can cause significant functional impairment that justifies temporary absence from school, work, or other activities, particularly during acute phases or when medical complications are present. Documentation on certificates should be appropriately detailed without unnecessarily violating privacy - one can use "eating disorder" as a general description if complete specificity is not necessary. The duration of absence should be based on individual clinical assessment, considering symptom severity, functional impact, and treatment needs. In school settings, it may be appropriate to provide accommodations (such as allowing meals in a private environment) rather than complete absence.

5. Can rumination-regurgitation disorder coexist with other mental disorders?

Yes, comorbidities are common. Anxiety disorders, particularly social anxiety and generalized anxiety disorder, frequently coexist with rumination-regurgitation disorder. Some patients present with obsessive-compulsive disorder or obsessive-compulsive features. In populations with developmental disabilities, rumination may coexist with autism spectrum disorder or intellectual disability. Depression may develop secondarily to the functional and social impact of the disorder. When comorbidities are present, both conditions should be coded and treated. Integrated treatment addressing both rumination and comorbid conditions generally produces better results than focusing exclusively on one condition.

6. What are the possible medical complications of rumination-regurgitation disorder?

Various medical complications can result from chronic rumination. Dental problems include erosion of tooth enamel due to repeated exposure to gastric acid, increasing risk of cavities and tooth sensitivity. Gastrointestinal complications include esophagitis (inflammation of the esophagus), possible esophageal stricture in severe cases of long duration, and rarely Mallory-Weiss Syndrome (lacerations at the esophagogastric junction). Nutritional complications may include malnutrition, specific vitamin and mineral deficiencies, and weight loss when a significant proportion of regurgitated food is spit out rather than reswallowed. Electrolyte imbalances, particularly hypokalemia and hypochloremia, may occur. Halitosis (bad breath) is common. Aspiration of regurgitated content can rarely cause respiratory problems. Regular medical monitoring is important for early detection and management of complications.

7. Is rumination always intentional or can it be involuntary?

This is a complex question that reflects the nature of the disorder. Although diagnostic criteria describe regurgitation as "intentional and repeated," many patients describe the behavior as partially automatic or habitual, particularly after prolonged establishment of the pattern. What distinguishes rumination-regurgitation disorder from purely organic causes of regurgitation is that the patient has some degree of control over the behavior - can suppress it temporarily when motivated, although this may require significant conscious effort. The behavior frequently begins as a response to gastrointestinal discomfort or another situation, but becomes conditioned and habitual over time. This partially automatic nature does not invalidate the diagnosis; in fact, the habitual component is an important target of behavioral interventions such as habit reversal training.

8. Do children with rumination-regurgitation disorder always have other developmental problems?

Not necessarily. Although rumination-regurgitation disorder is more common in individuals with developmental disabilities, particularly moderate to severe intellectual disability, many children and adolescents with rumination have typical cognitive development and normal general functioning in other areas. The disorder may occur in isolation or in the context of other mental disorders (such as anxiety), but is not exclusive to populations with developmental disabilities. When it occurs in individuals with typical development, the prognosis with appropriate treatment is generally favorable. Assessment should always consider the global developmental context, but the presence of rumination does not necessarily imply other developmental problems.

---

Conclusion:

Rumination-regurgitation disorder (ICD-11: 6B85) represents a specific eating condition that requires appropriate recognition, assessment, and treatment. Correct coding is fundamental for precise clinical communication, access to specialized treatments, and adequate epidemiological tracking. Health professionals should familiarize themselves with specific diagnostic criteria, carefully differentiate from other conditions with similar presentation, and exclude organic causes before establishing the diagnosis. With early identification and appropriate intervention, many patients experience significant improvement, highlighting the importance of adequate knowledge about this frequently underdiagnosed condition.

External References

This article was prepared based on reliable scientific sources:

1. 🌍 WHO ICD-11 - Rumination-regurgitation disorder
2. 🔬 PubMed Research on Rumination-regurgitation disorder
3. 🌍 WHO Health Topics
4. 📋 NICE Mental Health Guidelines
5. 📊 Clinical Evidence: Rumination-regurgitation disorder
6. 📋 Ministry of Health - Brazil
7. 📊 Cochrane Systematic Reviews

References verified on 2026-02-03