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ICD-10 Guide
ICD-10 CodesF33.3

F33.3

Billable

Major depressive disorder, recurrent, severe with psychotic symptoms

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

Code Description

ICD-10 F33.3 is a billable code used to indicate a diagnosis of major depressive disorder, recurrent, severe with psychotic symptoms.

Key Diagnostic Point:

F33.3 refers to a severe form of major depressive disorder characterized by recurrent episodes that include psychotic symptoms such as hallucinations or delusions. This condition significantly impairs an individual's ability to function in daily life and often requires intensive treatment. Patients may experience profound sadness, loss of interest in previously enjoyed activities, changes in appetite or sleep patterns, and feelings of worthlessness or excessive guilt. The presence of psychotic features complicates the clinical picture, as these symptoms can lead to further distress and functional impairment. Treatment typically involves a combination of pharmacotherapy, including mood stabilizers and antidepressants, and psychotherapy. Given the severity of the disorder, there is a heightened risk of suicide, necessitating thorough risk assessments and safety planning. Accurate diagnosis and coding are crucial for appropriate treatment and reimbursement.

Code Complexity Analysis

Complexity Rating: High

High Complexity

Complexity Factors

  • Presence of psychotic symptoms complicates diagnosis and treatment.
  • Differentiation from other mood disorders, such as bipolar disorder.
  • Need for comprehensive documentation of recurrent episodes.
  • Assessment of suicide risk requires detailed clinical notes.

Audit Risk Factors

  • Inadequate documentation of psychotic symptoms.
  • Failure to assess and document suicide risk.
  • Lack of evidence for recurrent episodes.
  • Misclassification of the severity of depression.

Specialty Focus

Medical Specialties

Psychiatry

Documentation Requirements

Detailed mental status examinations, treatment plans, and progress notes.

Common Clinical Scenarios

Patients presenting with severe depression and hallucinations or delusions.

Billing Considerations

Documentation must clearly outline the severity and impact of psychotic symptoms on functioning.

Primary Care

Documentation Requirements

Comprehensive history, physical examination findings, and mental health assessments.

Common Clinical Scenarios

Patients with depressive symptoms referred for psychiatric evaluation.

Billing Considerations

Primary care providers should document any changes in mood, behavior, and functional status.

Coding Guidelines

Inclusion Criteria

Use F33.3 When
  • According to ICD
  • 10 guidelines, F33
  • 3 should be used when the patient has a documented history of recurrent major depressive episodes with severe symptoms and psychotic features
  • Documentation must support the diagnosis, including the presence of hallucinations or delusions

Exclusion Criteria

Do NOT use F33.3 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

90837CPT Code

Psychotherapy, 60 minutes with patient

Clinical Scenario

Used for patients with severe depression and psychotic symptoms requiring intensive therapy.

Documentation Requirements

Document the duration of the session and the therapeutic interventions used.

Specialty Considerations

Psychiatrists should note the complexity of the case in their notes.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of mental health disorders, including the differentiation of major depressive disorder with psychotic features, which enhances treatment planning and reimbursement accuracy.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of mental health disorders, including the differentiation of major depressive disorder with psychotic features, which enhances treatment planning and reimbursement accuracy.

Reimbursement & Billing Impact

reimbursement accuracy.

Resources

Clinical References

  • •
    American Psychiatric Association - Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Coding & Billing References

  • •
    American Psychiatric Association - Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

Frequently Asked Questions

What are the key symptoms of F33.3?

Key symptoms include severe depressive episodes, psychotic features such as hallucinations or delusions, and significant impairment in daily functioning.