The diagnostic code for bipolar | disorder is based on type of current or most recent epi- sode and its status with respect to current severity, presence of psychotic features, and remission status. Current severity and psychotic features are only indicated if full criteria are currently met for a manic or major depressive episode. Remission specifiers are only indicated if the full criteria are not currently met for a manic, hypomanic, or major depres- sive episode. Codes are as follows:
Mild (p. 154) 296.41 NA 296.51 NA (F31.11) (F3131)
Moderate (p. 154) 296.42 NA 296.52 NA (F31.12) (F3132)
Severe (p. 154) 296.43 NA 296.53 NA (F31.13) (F31.4) 1In distinguishing grief from a major depressive episode (MDE), it is useful to consider that in grief the predominant affect is feelings of emptiness and loss, while in MDE it is persistent depressed mood and the inability to anticipate happiness or pleasure. The dysphoria in grief is likely to decrease in intensity over days to weeks and occurs in waves, the so-called pangs of grief. These waves tend to be associated with thoughts or reminders of the deceased. The depressed mood of a MDE is more persistent and not tied to specific thoughts or preoccupations.
The pain of grief may be accompanied by positive emotions and humor that are uncharacteristic of the pervasive unhappiness and misery characteristic of a major depressive episode. The thought content associated with grief generally features a preoccupation with thoughts and memories of the deceased, rather than the self—critical or pessimistic ruminations seen in a MDE.
In grief, self—esteem is generally preserved, whereas in a MDE, feelings of worthlessness and self— loathing are common. If self-derogatory ideation is present in grief, it typically involves per- ceived failings vis-a—vis the deceased (e.g., not visiting frequently enough, not telling the deceased how much he or she was loved). If a bereaved individual thinks about death and dying, such thoughts are generally focused on the deceased and possibly about ”joining" the deceased, whereas in a major depressive episode such thoughts are focused on ending one’s own life because of feeling worthless, undeserving of life, or unable to cope with the pain of depression.
With psychotic 296.44 NA 296.54 NA features‘“ (F312) (F31.5) (p. 152)
In partial 296.45 296.45 296.55 NA remission (p. 154) (F31.73) (F31.73) (F3175)
In full remission 296.46 296.46 296.56 NA (p. 154) (F31.74) (F31.74) (F31.76)
Unspecified 296.40 296.40 296.50 NA (F31 9.) (F319) (F31. 9) :Severity and psychotic specifiers do not apply; code 296. 40 (F31. 0) for cases not in remission.
Severity, psychotic, and remission specifiers do not apply. Code 296. 7 (F31. 9).
“*If psychotic features are present, code the’ ’with psychotic features" specifier irrespective of epi- sode severity.
In recording the name of a diagnosis, terms should be listed in the following order: bipolar
I disorder, type of current or most recent episode, severity/psychotic/remission specifiers, followed by as many specifiers without codes as apply to the current or most recent epi- sode.
Specify:
Wlth anxious distress (p. 149)