The diagnostic code for major depressive disorder is based on whether this is a single or recurrent episode, current severity, presence of psychotic features, and remission status.
Current severity and psychotic features are only indicated it full criteria are currently met for a major depressive episode. Remission specifiers are only indicated if the full criteria are not currently met for a major depressive episode. Codes are as follows:
Mild (p. 188) 296.21 (F320) 296.31 (F330)
Moderate (p. 188) 296.22 (F321) 296.32 (F33.1)
Severe (p. 188) 296.23 (F322) 296.33 (F332)
With psychotic features“ (p. 186) 296.24 (F323) 296.34 (F333)
In partial remission (p. 188) 296.25 (F32.4) 296.35 (F33.41)
In full remission (p. 188) 296.26 (F325) 296.36 (F33.42)
Unspecified 296.20 (F329) 296.30 (F33.9) ‘For an episode to be considered recurrent, there must be an interval of at least 2 consecutive months between separate episodes in which criteria are not met for a major depressive episode. The defini- tions of specifiers are found on the indicated pages.
"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: major depressive disorder, single or recurrent episode, severity/psychotic/remission specifiers, followed by as many of the following specifiers without codes that apply to the current episode.
Specify:
With anxious distress (p. 184)
With mixed features (pp. 184—185)
With melancholic features (p. 185)
With atypical features (pp. 185—186)
With mood-congruent psychotic features (p. 186)
With mood-incongruent psychotic features (p. 186)
With catatonia (p. 186). Coding note: Use additional code 293.89 (F06.1).
With peripartum onset (pp. 186—187)
With seasonal pattern (recurrent episode only) (pp. 187—188)
The criterion symptoms for major depressive disorder must be present nearly every day to be considered present, with the exception of weight change and suicidal ideation. De- pressed mood must be present for most of the day, in addition to being present nearly ev- ery day. Often insomnia or fatigue is the presenting complaint, and failure to probe for accompanying depressive symptoms will result in underdiagnosis. Sadness may be de- demeanor. With individuals who focus on a somatic complaint, clinicians should de- termine whether the distress from that complaint is associated with specific depressive symptoms. Fatigue and sleep disturbance are present in a high proportion of cases; psy- chomotor disturbances are much less common but are indicative of greater overall sever- ity, as is the presence of delusional or near-delusional guilt.
The essential feature of a major depressive episode is a period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activi- ties (Criterion A). In children and adolescents, the mood may be irritable rather than sad.