F33.3
BillableMajor depressive disorder, recurrent, severe with psychotic symptoms
HCC Category Mapping
V28HCC 152 — Delusional and Other Specified Psychotic Disorders
0.546V24HCC 59 — Major Depressive, Bipolar, and Paranoid Disorders
0.309ESRDHCC 59 — Major Depressive, Bipolar, and Paranoid Disorders
0.000RxHCCHCC 132 — Major Depressive Disorder and Other Mood Disorders
0.000What This Code Means
Multiple episodes of severe depression with hallucinations or delusions (false beliefs or perceptions) occurring during depressive episodes.
Coding Tips
- •Clearly document the presence of psychotic symptoms and their relationship to the depressive episode
- •Specify whether psychotic features are mood-congruent (consistent with depressed mood) or mood-incongruent
Clinical Significance
Major depressive disorder, recurrent, severe with psychotic symptoms represents the most acute form of recurrent depression, combining severe depressive symptoms with psychotic features. This is a high-acuity psychiatric condition that typically requires inpatient hospitalization, dual pharmacotherapy with antidepressants and antipsychotics, and sometimes electroconvulsive therapy. The recurrent pattern with psychotic features indicates a particularly treatment-resistant trajectory.
Documentation Requirements
- ✓Provider documentation of recurrent major depressive disorder
- ✓History of at least two separate major depressive episodes
- ✓Current episode documented as severe
- ✓Specific psychotic features documented: delusions (guilt, nihilistic, somatic) and/or hallucinations
- ✓Mental status examination documenting psychotic findings
- ✓Suicide risk assessment
- ✓Antipsychotic medication prescribed alongside antidepressant
- ✓Hospitalization documentation if applicable
Commonly Confused Codes
F33.2 — Major depressive disorder, recurrent, severe without psychotic features: No psychotic symptomsF32.3 — Major depressive disorder, single episode, severe with psychotic features: First episode onlyF31.5 — Bipolar disorder, depressed, severe with psychotic features: Bipolar history presentF25.1 — Schizoaffective disorder, depressive type: Psychosis persists between mood episodes
Code Hierarchy
└F33Major depressive disorder, recurrent└F33.3Major depressive disorder, recurrent, severe with psychotic symptoms
└F33.3Major depressive disorder, recurrent, severe with psychotic symptoms