Tag Archives: Major Depressive Disorder

depressive disorder

ICD 10 – Coding Tips For Depressive Disorders

Coding for Major Depressive Disorder

 F32. Major depressive disorder, single episode

 According to the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM‐5) , five or more of the symptoms listed below must be present during the same 2‐week time period that represents changes in functioning. At least one symptom is either a depressed mood or loss of interest.

  • Depressed mood most of the day, nearly every day, as indicated in the subjective report or in observation made by others
  • Markedly diminished interest in pleasure in all, or almost all, activities most of the day and nearly every day
  • Significant weight loss when not dieting or weight gain, for example, more than 5 percent of body weight in a month or changes in appetite nearly every day
  • Insomnia or hypersomnia nearly every day
  • Psychomotor agitation or retardation nearly every day
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt
  • Diminished ability to think or concentrate, or indecisiveness nearly every day
  • Recurrent thoughts of death

 The ICD‐10 classification of Mental and Behavioral Disorders developed in part by the American Psychiatric Association classifies depression by code. In typical, mild, moderate, or severe depressive episodes the patient suffers from lowering of mood, reduction of energy and decrease in activities. Their capacity for enjoyment, interest, and concentration is reduced and is marked by tiredness after even a minimum of effort is common. Sleep patterns are usually disturbed and appetite diminished along with reduced self‐confidence and self‐esteem.

 Final code selection is based on severity (mild, moderate, severe) and status.  Depending on the number and severity of the symptoms, a depressive episode may be specified as mild, moderate, or severe.

For mild depressive episodes two or three symptoms from the data below are usually present. The general criteria for depressive episode must be met.

 At least two of the following three symptoms must be present:

 Depressed mood to a degree that is definitely abnormal to the individual, present for most of the day and almost every day, largely uninfluenced by circumstances, and sustained for at least two weeks

 Loss of interest or pleasure in activities that are normally pleasurable

 Decreased energy or increased fatigability

 An additional symptom or symptoms from the following list should be present to give a total of at least four:

 Loss of confidence or self‐esteem

 Unreasonable feelings of self‐reproach or excessive and inappropriate guilty

 Recurrent thoughts of death or any suicidal behavior

Complaints or evidence of diminished ability to think or concentrate, such as indecisiveness or vacillation

Change in psychomotor activity, with agitation or retardation (either subjective or objective)

 Sleep disturbance of any type

 Change in appetite (decrease or increase) with corresponding weight change

 For moderate depressive episodes four or more of the symptoms noted above are usually present and the patient is likely to have great difficulty in continuing with ordinary activities.

 For a classification of in remission the patient has had two or more depressive episodes in the past but has been free from depressive symptoms for several months. This category can still be used if the patient is receiving treatment to reduce the risk of further episodes. It will be based on the provider’s clinical determination and documentation.

 F32.0 Major depressive disorder, single episode, mild

F32.1 Major depressive disorder, single episode, moderate

F32.2 Major depressive disorder, single episode, severe without psychotic features

F32.3 Major depressive disorder, single episode, severe with psychotic features F32.4 Major depressive disorder, single episode, in partial remission

F32.5 Major depressive disorder, single episode, in full remission

 F33 Major depressive disorder, recurrent

 A recurrent depressive disorder is characterized by repeated episodes of depression without any history of independent episodes of mood elevation and increased energy or mania. There has been at least one previous episode lasting a minimum of two weeks and separated by the current episode of at least two months. At no time in the past has there been any hypomanic or manic episodes.

 F33.0 Major depressive disorder, recurrent, mild

F33.1 Major depressive disorder, recurrent, moderate

F33.2 Major depressive disorder, recurrent, severe without psychotic features F33.3 Major depressive disorder, recurrent, severe with psychotic features

 F33.4 Major depressive disorder, recurrent, in remission

 For a classification of in remission the patient has had two or more depressive episodes in the past but has been free from depressive symptoms for several months. This category can still be used if the patient is receiving treatment to reduce the risk of further episodes. It will be based on the provider’s clinical determination and documentation.

 F33.40 Major depressive disorder, recurrent, in remission, unspecified F33.41 Major depressive disorder, recurrent, in partial remission

F33.42 Major depressive disorder, recurrent, in full remission