Major Depressive Disorder

Major depressive disorder

According to the American Psychiatric Association, major depressive disorder can be seen in patients who have suffered a depressive episode lasting at least two weeks, as manifested by at least five of the following symptoms: depressed mood, loss of interest or pleasure in most or all activities, insomnia or hypersomnia, change in appetite or weight, psychomotor retardation or agitation, low energy, poor concentration, thoughts of worthlessness or guilt, and recurrent thoughts about death or suicidal ideation. Major depression is highly recurrent, with recurrent episodes occurring in 50% or more of patients.

Remission and recovery from major depression
Whether or not a patient is being treated for depression (e.g., counseling and/or medication), remission can be defined as a level of depressive symptoms basically indistinguishable from that in someone who has never been depressed. When reporting history of major depressive disorder, instead of coding V11.1 (i.e., personal history of affective disorders), consider using a code from the mental disorders chapter with the fifth digit for in remission.

Always remember...

When documenting major depressive disorder, it is important to document the:

- Episode (single or recurrent)

- Severity (mild, moderate, severe without psychotic features or severe with psychotic features)

- Clinical status of the current episode (in partial/full remission)

 

Documentation and coding tips

ICD-9-CM and ICD-10-CM both include codes for recurrent depressive disorders, as well as those in “partial or full remission.” 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

- At least one previous episode lasting a minimum of two weeks and separated by the current episode of at least two months

- No past hypomanic or manic episodes

- 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.

 

#HCC

This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. The information presented herein is for general informational purposes only.