F32.3
BillableMajor depressive disorder, single episode, severe with psychotic features
HCC Category Mapping
What This Code Means
A severe form of depression occurring as a single episode where the patient experiences psychotic symptoms such as hallucinations or delusions. This represents the most serious presentation of a first depressive episode.
Coding Tips
- •Verify documentation clearly states this is a single episode (not recurrent) and includes both severe depression AND psychotic features to justify this specific code
- •Ensure the psychotic features are documented as mood-congruent or mood-incongruent, and consider if additional codes are needed for specific psychotic symptoms
Clinical Significance
Major depressive disorder, single episode, severe with psychotic features represents a first-time psychotic depression, one of the most acute psychiatric presentations combining profound depression with psychotic symptoms. These patients are at extremely high suicide risk and almost always require inpatient hospitalization. Psychotic depression has a distinct neurobiology and treatment approach, typically requiring both antidepressant and antipsychotic medications.
Documentation Requirements
- ✓Provider documentation of major depressive disorder with full diagnostic criteria
- ✓Single episode confirmed — no prior depressive episodes
- ✓Severity documented as severe
- ✓Specific psychotic features documented: mood-congruent delusions (guilt, worthlessness, disease, poverty) and/or hallucinations
- ✓Mental status examination documenting psychotic findings
- ✓Suicide risk assessment
- ✓Antipsychotic medication prescribed alongside antidepressant
- ✓Hospitalization documentation if applicable