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ICD-10 Guide
ICD-10 CodesF06.31

F06.31

Billable

Mood disorder due to known physiological condition with depressive features

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 F06.31 is a billable code used to indicate a diagnosis of mood disorder due to known physiological condition with depressive features.

Key Diagnostic Point:

F06.31 refers to mood disorders that arise as a direct result of a known physiological condition, characterized by depressive features. These mood disorders can be secondary to various medical conditions such as endocrine disorders (e.g., hypothyroidism), neurological conditions (e.g., stroke, traumatic brain injury), or chronic illnesses (e.g., cancer, chronic pain syndromes). The depressive features may manifest as persistent sadness, loss of interest or pleasure in activities, changes in appetite or weight, sleep disturbances, fatigue, feelings of worthlessness, and difficulty concentrating. It is crucial for clinicians to differentiate these mood disorders from primary mood disorders, as the treatment approach may differ significantly. Accurate diagnosis requires a thorough clinical evaluation, including a detailed medical history and assessment of the physiological condition contributing to the mood disorder. Treatment often involves addressing the underlying physiological condition alongside psychiatric interventions, such as psychotherapy or pharmacotherapy.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires understanding of both psychiatric and physiological conditions.
  • Need for comprehensive documentation linking mood disorder to the physiological condition.
  • Potential overlap with other mood disorder codes.
  • Variability in clinical presentation based on the underlying condition.

Audit Risk Factors

  • Insufficient documentation linking mood disorder to the physiological condition.
  • Inconsistent coding of mood disorders in relation to treatment plans.
  • Failure to update codes based on changes in the patient's physiological condition.
  • Lack of interdisciplinary notes that support the diagnosis.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed psychiatric evaluation, including history of present illness, mental status examination, and treatment plan.

Common Clinical Scenarios

Patients with chronic illnesses presenting with depressive symptoms, requiring psychiatric assessment.

Billing Considerations

Consideration of medication side effects from treatments of the physiological condition that may exacerbate mood symptoms.

Neurology

Documentation Requirements

Neurological assessment, imaging results, and correlation of neurological findings with mood symptoms.

Common Clinical Scenarios

Patients with stroke or traumatic brain injury presenting with mood changes.

Billing Considerations

Documentation should clearly outline the neurological condition and its impact on mood.

Coding Guidelines

Inclusion Criteria

Use F06.31 When
  • According to ICD
  • 10 guidelines, F06
  • 31 should be used when the mood disorder is directly attributable to a known physiological condition
  • Documentation must clearly establish this link

Exclusion Criteria

Do NOT use F06.31 When
  • Exclusion criteria include primary mood disorders that are not caused by physiological conditions

Related ICD-10 Codes

Related CPT Codes

99213CPT Code

Established patient office visit, Level 3

Clinical Scenario

Used for follow-up visits for patients with mood disorders related to physiological conditions.

Documentation Requirements

Document the patient's mood symptoms, treatment plan, and any changes in the physiological condition.

Specialty Considerations

Psychiatrists should ensure that the link between the mood disorder and the physiological condition is clearly documented.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of mood disorders related to physiological conditions, improving the accuracy of diagnosis and treatment planning. It emphasizes the need for clear documentation linking mood symptoms to medical conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of mood disorders related to physiological conditions, improving the accuracy of diagnosis and treatment planning. It emphasizes the need for clear documentation linking mood symptoms to medical conditions.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of mood disorders related to physiological conditions, improving the accuracy of diagnosis and treatment planning. It emphasizes the need for clear documentation linking mood symptoms to medical conditions.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between F06.31 and primary mood disorder codes?

F06.31 is specifically for mood disorders that are secondary to known physiological conditions, while primary mood disorder codes (like F32 or F33) are used when the mood disorder is not linked to any identifiable medical condition.