Depression coding shouldn’t trigger claim denials. With 21 million American adults experiencing depression annually (NIMH), F32 and F33 codes appear in clinics daily. One wrong code means delayed payments and frustrated billing teams.
The 2025 ICD-10-CM update kept depression codes stable but increased documentation scrutiny. Here’s how to code correctly and pass audits.
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TALK TO AN EXPERTUnderstanding F32 vs F33: The Two-Month Rule
ICD-10-CM splits depression into two families based on episode history:
- F32 Series First-time presentations
- F33 Series Previous episode with at least two months of full recovery
This two-month threshold causes 30% of depression-related denials because practices skip documenting recovery periods.
Single Episode Codes (F32)
Pick severity based on function, not symptoms. About 60% of cases start here:
| Code | Description | Clinical Picture |
| F32.0 | Mild | Working but struggling |
| F32.1 | Moderate | Missing work, declining function |
| F32.2 | Severe | Unable to function |
| F32.3 | Severe with psychosis | Hallucinations present |
| F32.4 | Partial remission | Improving |
| F32.5 | Full remission | Recovered |
| F32.9 | Unspecified | Last resort only |
Recurrent Depression Codes (F33)
Use when previous episodes exist with documented recovery gaps:
| Code | Description | Clinical Reality |
| F33.0 | Mild recurrent | Pattern established, manageable |
| F33.1 | Moderate recurrent | Pattern with real struggles |
| F33.2 | Severe, no psychosis | Pattern with major impairment |
| F33.3 | Severe with psychosis | Pattern with reality disturbance |
| F33.41 | Partial remission | Improving between episodes |
| F33.42 | Full remission | Recovered but history exists |
| F33.9 | Unspecified | Pattern unclear |
Severity Determination
Base severity on functional impairment aligned with DSM-5-TR:
Mild: Works and socializes despite distress. Self-care intact.
Moderate: Can’t maintain work performance. Missing days. Self-care declining.
Severe: Unable to work or maintain relationships. Self-care compromised. Suicidal ideation common.
When proper coding practices matter, document specific limitations.
Special Classification Codes
Three subtypes live outside F32/F33. The 2025 update kept codes but demanded better documentation. Understanding psychiatry billing nuances prevents these headaches.
| Condition | Code | Criteria |
| Dysthymia | F34.1 | Symptoms ≥2 years |
| Postpartum Depression | F53.0 | Within 4 weeks postpartum |
| Seasonal Affective | F33.9 | Use recurrent MDD |
Documentation That Survives Audits
After hundreds of payer audits, vague notes sink claims. CMS documentation rules require specifics:
- Symptoms with frequency and duration
- Quantified functional impact (work, social, self-care)
- Previous episode dates (for F33)
- Treatment response
- Mental status findings
Example that works: “Daily crying, 15-lb weight loss over 6 weeks, sleeping 12+ hours daily. Missed 8 of last 10 workdays. Previous episode 2019, fully remitted by 2020. Current episode started 6 weeks ago.”
Supports F33.1 (moderate recurrent).
Example that fails: “Patient depressed, started medication.”
Result: Denied for inadequate documentation.
2025 Updates You Need to Know
October 2024 kept codes unchanged but Medicare Administrative Contractors now scrutinize:
- Functional outcomes
- Treatment response details
- Comorbidity clarification
- Severity justification
Regional rules vary, Florida requirements differ from California. One practice caught an LCD change early and avoided $50,000 in denials. Track your MAC region.
Five Coding Mistakes Killing Your Claims
- Defaulting to F32.9/F33.9 Signals poor assessment, triggers audits
- Missing episode history F33 without dates = automatic denial
- Severity by symptoms alone Function matters more
- Missing bipolar history Leads to wrong depression coding
- Vague functional descriptions “Unable to work” needs specifics
Best Practices That Work
Document smart:
- Measure function in concrete terms (days missed, tasks incomplete)
- Record episode dates with recovery periods
- Use PHQ-9 or Beck Depression Inventory scores
- Keep unspecified codes under 15% of total depression diagnoses
Audit yourself:
- Review 10-15 charts monthly
- Track denials by code type
- Update protocols when MAC rules change
Why Proper Coding Matters
Choosing F32.1 over F32.9 takes 30 seconds but delivers:
- 40% fewer denials
- 2-3 weeks faster payment
- Audit protection
- Accurate patient records
Your billing team gets less rework. Your bank account fills faster. Your patients get accurate records. The advantages of proper coding extend beyond payment.
Need help with mental health billing? We handle coding details daily, backed by 15+ years processing behavioral health claims.
Disclaimer: Informational purposes only. Not legal, financial, or coding advice. Verify codes with current ICD-10-CM guidelines and insurance carriers before submitting claims.
FAQ
Q: What’s the F32 vs F33 difference?
F32 = first episode. F33 = previous episode with 2+ months recovery documented.
Q: Can I use F32.9 if unsure?
Only as last resort. It invites audits and signals inadequate assessment.
Q: How do I prove two-month recovery?
Document when symptoms stopped, functional return (returned to work, resumed activities) and symptom-free interval.
Q: Code both depression and anxiety?
Yes. Use F32/F33 for depression and F41.x for anxiety when both exist.
Q: How often should severity change?
As treatment progresses toward remission. Document clinical rationale for shifts.