F32.9
F32 — Major depressive disorder, single episode
Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders (F01-F99)
F30-F39 — Mood [affective] disorders
Clinical Definition
Major depressive disorder (MDD), single episode, unspecified — coded as F32.9 under ICD-10-CM — refers to a first or isolated episode of clinical depression in which the severity level has not been specified in the documentation. A major depressive episode is defined by the presence of at least five of nine DSM-5 criteria persisting for a minimum of two weeks, with at least one symptom being depressed mood or markedly diminished interest or pleasure (anhedonia). Other qualifying symptoms include significant weight or appetite changes, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness or excessive guilt, diminished concentration, and recurrent thoughts of death or suicidal ideation.
F32.9 is the appropriate code when the provider confirms a single (first-lifetime) episode of major depressive disorder but does not characterize the severity as mild (F32.0), moderate (F32.1), severe without psychotic features (F32.2), or severe with psychotic features (F32.3). This code serves as the default within the F32 category and is frequently used in primary care and initial psychiatric evaluations where formal severity stratification has not been completed.
The Patient Health Questionnaire-9 (PHQ-9) is the most widely used validated instrument for severity grading. PHQ-9 scores align with ICD-10 severity codes: 5-9 (mild, F32.0), 10-14 (moderate, F32.1), 15-19 (moderately severe, F32.1 or F32.2), and 20-27 (severe, F32.2 or F32.3). When a PHQ-9 score is documented but the provider does not translate it into a severity qualifier, the coder is limited to F32.9. Best practice is to query the provider so a more precise code can be assigned, but absent such clarification, F32.9 remains the correct default.
When to Use F32.9
- ✓The provider documents a diagnosis of major depressive disorder, single episode, without specifying whether the severity is mild, moderate, or severe.
- ✓A patient presents with a first-lifetime major depressive episode confirmed by DSM-5 criteria, but the clinical note does not include a severity level or a standardized severity instrument score such as the PHQ-9.
- ✓The provider documents 'depression, single episode' or 'major depression NOS' and the episode has been confirmed as the patient's first occurrence, with no prior history of depressive episodes.
- ✓An initial psychiatric or primary care evaluation establishes a working diagnosis of major depressive disorder, single episode, and severity grading is deferred pending further assessment or completion of rating scales.
- ✓The documentation states 'major depressive disorder, single episode, unspecified' or uses equivalent language indicating a single episode without severity qualification.
- ✓Follow-up encounters for an ongoing single depressive episode where the severity was never formally specified in the original or subsequent documentation and the provider has not responded to coding queries.
Common Coding Mistakes
- ⚠Using F32.9 when the documentation includes a PHQ-9 score or explicit severity language. If the provider documents 'moderate depression' or the PHQ-9 score is 10-14, the correct code is F32.1 (moderate), not F32.9. Always check the note for severity indicators before defaulting to the unspecified code.
- ⚠Confusing F32.9 (single episode) with F33.9 (recurrent, unspecified). F32.9 applies only when the current episode is the patient's first documented episode of major depressive disorder. If the patient has a history of one or more prior depressive episodes, the correct code is F33.9 or a more specific F33 code. Review the psychiatric history carefully to determine episode count.
- ⚠Assigning F32.9 for dysthymia or persistent depressive disorder. Dysthymia (persistent depressive disorder) is a chronic, lower-grade depressive condition lasting at least two years and is coded as F34.1, not F32.9. The distinction hinges on chronicity and symptom intensity — MDD episodes are more acute and severe.
- ⚠Using F32.9 for adjustment disorder with depressed mood. Adjustment disorder with depressed mood (F43.21) requires an identifiable stressor and onset within three months of that stressor, whereas MDD does not require an identifiable precipitant. Coding adjustment disorder as MDD inflates disease severity and may affect treatment authorization.
- ⚠Failing to query the provider for severity specification. Coding guidelines encourage specificity; if the clinical note contains enough information to determine severity (e.g., functional impairment descriptions, PHQ-9 scores, or GAD-7 alongside clinical impressions), a query should be sent to the provider before defaulting to F32.9.
- ⚠Reporting F32.9 alongside F32.0, F32.1, or F32.2 for the same episode. Only one F32 code should be assigned per depressive episode. If severity is subsequently determined during the same encounter or admission, replace F32.9 with the more specific code rather than reporting both.
Related & Differential Codes
| Code | Description | Relationship |
|---|---|---|
| F32.0 | Major depressive disorder, single episode, mild | More specific |
| F32.1 | Major depressive disorder, single episode, moderate | More specific |
| F32.2 | Major depressive disorder, single episode, severe without psychotic features | More specific |
| F32.3 | Major depressive disorder, single episode, severe with psychotic features | More specific |
| F32.4 | Major depressive disorder, single episode, in partial remission | Sibling |
| F32.5 | Major depressive disorder, single episode, in full remission | Sibling |
| F32 | Major depressive disorder, single episode (category) | Parent |
| F33.9 | Major depressive disorder, recurrent, unspecified | Related |
| F33.0 | Major depressive disorder, recurrent, mild | Related |
| F34.1 | Dysthymic disorder (persistent depressive disorder) | Related |
| F41.9 | Anxiety disorder, unspecified | Related |
| F43.21 | Adjustment disorder with depressed mood | Excludes |
| F31.9 | Bipolar disorder, unspecified | Excludes |
Documentation Requirements
- 1Document the specific DSM-5 criteria met by the patient, including the duration of symptoms (minimum two weeks) and the number and type of qualifying symptoms (depressed mood, anhedonia, weight/appetite changes, sleep disturbance, psychomotor changes, fatigue, worthlessness/guilt, concentration difficulties, suicidal ideation).
- 2Specify whether the current episode is a single (first-lifetime) episode or a recurrent episode. Review the patient's psychiatric history, prior treatment records, and patient-reported history to establish episode count. If this is the first episode, document that explicitly.
- 3Include severity assessment using a validated instrument such as the PHQ-9 and document the score in the clinical note. Translate the score into a severity qualifier (mild, moderate, moderately severe, or severe) in the assessment or diagnosis line to support the most specific code assignment.
- 4Document functional impairment caused by the depressive episode, including impact on occupational performance, social relationships, activities of daily living, and self-care. This supports medical necessity for the level of treatment provided.
- 5Record the presence or absence of psychotic features (hallucinations, delusions) and suicidal ideation, plan, or intent. Psychotic features change the code to F32.3 and suicidality documentation is critical for risk management and treatment planning.
- 6Note any relevant comorbid psychiatric conditions (anxiety disorders, substance use disorders, PTSD) and medical comorbidities (chronic pain, hypothyroidism, neurological conditions) that may complicate or contribute to the depressive presentation.
- 7Document the treatment plan, including psychotherapy type and frequency, pharmacotherapy (medication name, dose, duration), referrals to psychiatry or psychology, and safety planning if suicidal ideation is present.
- 8For follow-up encounters, document treatment response, medication adherence, side effects, updated PHQ-9 scores, and any changes to the severity classification or treatment plan.
Reimbursement & Billing Notes
F32.9 is a valid, billable ICD-10-CM code accepted by Medicare, Medicaid, and all major commercial payers for reimbursement purposes. It supports claims for psychiatric evaluation (CPT 90791, 90792), psychotherapy services (CPT 90832, 90834, 90837, and add-on codes 90833, 90836, 90838 for psychotherapy with E/M), evaluation and management visits (CPT 99202-99215), and pharmacologic management. The code also supports PHQ-9 screening (CPT 96127 for brief emotional/behavioral assessment) and collaborative care management services (CPT 99492-99494). F32.9 is included in the CMS-approved depression screening codes under the Annual Wellness Visit benefit, and most commercial plans cover depression-related services under behavioral health parity requirements.
However, some payers may request additional documentation or may prefer a more specific severity code (F32.0-F32.3) to authorize certain levels of care, particularly intensive outpatient programs (IOP), partial hospitalization programs (PHP), or inpatient psychiatric admissions. Prior authorization for these higher levels of care frequently requires documentation of severity, functional impairment, and failure of lower-level interventions. While F32.9 alone will generally not trigger a claim denial for outpatient services, using a severity-specified code when documentation supports it can reduce audit risk and prior authorization barriers. Ensure that the documented PHQ-9 score, clinical assessment, and treatment plan are consistent with the billed diagnosis to avoid post-payment recoupment.
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Try Free — No Credit Card RequiredFrequently Asked Questions
What is the ICD-10 code for depression?
The most commonly used ICD-10 code for a single episode of major depression when severity is not specified is F32.9 (Major depressive disorder, single episode, unspecified). However, the appropriate code depends on severity and episode history. For mild depression, use F32.0; for moderate, F32.1; for severe without psychotic features, F32.2; and for severe with psychotic features, F32.3. If the patient has had prior depressive episodes, the recurrent codes (F33.0-F33.9) apply instead. For persistent low-grade depression lasting two or more years, dysthymia is coded as F34.1. Always match the code to the documented severity and episode count.
What is the difference between F32.9 and F33.9?
F32.9 (Major depressive disorder, single episode, unspecified) is used when the patient is experiencing their first documented episode of major depression and severity is not specified. F33.9 (Major depressive disorder, recurrent, unspecified) is used when the patient has a history of two or more distinct major depressive episodes separated by at least two months of partial or full remission, and the current episode's severity is unspecified. The critical distinction is episode count — single versus recurrent. Thorough review of the patient's psychiatric history, including prior treatments, hospitalizations, and medication trials, is essential for determining the correct category.
When should I use F32.9 versus F32.1 for depression coding?
Use F32.9 when the provider documents major depressive disorder, single episode, without specifying whether it is mild, moderate, or severe. Use F32.1 when the provider explicitly documents the depression as moderate in severity, or when a validated instrument such as the PHQ-9 yields a score in the moderate range (10-14) and the provider incorporates this into the diagnosis. ICD-10 coding guidelines favor the most specific code supported by the documentation. If the note contains enough information to determine severity — such as a PHQ-9 score, explicit severity language, or detailed functional impairment descriptions — F32.1 (or another severity-specific code) should be used instead of F32.9.
Can F32.9 be used for anxiety and depression together?
F32.9 codes only the major depressive disorder component. If a patient has both depression and anxiety, both conditions should be coded separately. For example, F32.9 for the depressive episode and F41.1 for generalized anxiety disorder, or F41.9 for anxiety disorder unspecified. There is a specific code F41.8 (other specified anxiety disorders) that includes anxiety depression (mild or not persistent), but this applies to mixed anxiety and depressive disorder that does not meet full criteria for either condition independently. If both MDD and an anxiety disorder are independently diagnosed, report both codes. The sequencing depends on the reason for the encounter — list the condition primarily responsible for the visit as the principal diagnosis.
What PHQ-9 score corresponds to ICD-10 code F32.9?
F32.9 does not correspond to a specific PHQ-9 score range because it is the 'unspecified' code, used when severity has not been determined or documented. However, PHQ-9 scores map to more specific F32 codes as follows: 5-9 corresponds to mild depression (F32.0), 10-14 to moderate depression (F32.1), 15-19 to moderately severe depression (typically F32.1 or F32.2 depending on clinical judgment), and 20-27 to severe depression (F32.2 or F32.3). If a PHQ-9 score is documented in the record, the provider should ideally translate it into a severity designation in the assessment so a more specific code can be assigned rather than defaulting to F32.9.
Is F32.9 a billable ICD-10 code and does it require prior authorization?
Yes, F32.9 is a valid, billable ICD-10-CM code accepted by Medicare, Medicaid, and commercial insurers. It does not typically require prior authorization for standard outpatient services such as office-based evaluation and management, psychotherapy, or antidepressant prescriptions. However, higher levels of care — including intensive outpatient programs, partial hospitalization, or inpatient psychiatric admission — usually require prior authorization, and many utilization review organizations prefer or require a severity-specific code (F32.1, F32.2, or F32.3) along with detailed documentation of functional impairment and treatment failure at lower levels of care. For routine outpatient claims, F32.9 is sufficient and will not trigger denials on its own.