F43.23: 2025 ICD-10-CM Adjustment Disorder

What Is Adjustment Disorder with Mixed Anxiety and Depressed Mood?

Adjustment disorder is a mental health condition triggered by an identifiable stressor, leading to emotional and behavioral challenges. The ICD-10-CM code F43.23 specifically denotes adjustment disorder with mixed anxiety and depressed mood, a prevalent subtype where individuals experience both anxiety and depression in response to a stressful event. This condition typically emerges within three months of the stressor and can significantly impact daily life, including work, school, or relationships.

Why Is F43.23 Important in Mental Health?

The F43.23 code is a critical tool in the U.S. healthcare system, used for accurate diagnosis, billing, and treatment planning. By identifying this specific subtype, clinicians can tailor interventions to address both anxiety and depressive symptoms, ensuring comprehensive care. Unlike international ICD-10 versions, which may use different codes, F43.23 is standardized for U.S. medical billing as of October 2023.

Symptoms of Adjustment Disorder (F43.23)

Adjustment disorder with mixed anxiety and depressed mood manifests through a range of symptoms, often tied to the stressor. Common signs include:

• Low mood: Persistent sadness, hopelessness, or tearfulness.
• Anxiety: Excessive worry, nervousness, or jitteriness.
• Irritability: Heightened frustration or agitation.
• Difficulty concentrating: Trouble focusing on tasks or making decisions.
• Lack of motivation: Reduced interest in daily activities.
• Interpersonal challenges: Strained relationships with family, friends, or colleagues.
• Work or academic struggles: Decreased performance due to emotional distress.

These symptoms must be disproportionate to the stressor’s severity and not meet the criteria for other mental health disorders, such as major depressive disorder or generalized anxiety disorder.

Diagnostic Criteria for F43.23

According to the DSM-5, adjustment disorder is diagnosed when:

1. Emotional or behavioral symptoms develop within three months of an identifiable stressor.
2. The distress is disproportionate to the stressor’s intensity or severity.
3. Symptoms cause significant impairment in social, occupational, or other areas of functioning.
4. The condition does not meet criteria for another mental health disorder or represent normal grief.
5. Cultural context is considered to ensure symptoms are not a typical response within the individual’s cultural framework.

Differential Diagnosis: Ruling Out Similar Conditions

Before diagnosing F43.23, clinicians must differentiate it from other disorders, including:

• Bereavement: Normal grief responses do not qualify as adjustment disorder.
• Post-Traumatic Stress Disorder (PTSD): Involves more severe trauma and prolonged symptoms.
• Major Depressive Disorder (MDD): Features persistent, intense depressive symptoms beyond a stressor.
• Anxiety Disorders: Characterized by chronic anxiety not tied to a specific stressor.
• Personality Disorders: Involve long-standing patterns of behavior, not acute stressor responses.

This careful differentiation ensures accurate diagnosis and effective treatment.

Prevalence and Impact of Adjustment Disorder

Adjustment disorder is a common mental health condition, with a prevalence rate of approximately 11.5% in the general population, according to a 2017 study by Yaseen Y. Adjustment disorder with mixed anxiety and depressed mood is the most frequent subtype, ranking as the 7th most common psychiatric condition in clinical settings (Maercker et al., 2017). Its high prevalence underscores the importance of clinician awareness and expertise in recognizing and treating this disorder.

Who Is at Risk?

Adjustment disorder can affect anyone, but certain stressors increase the likelihood, including:

• Life transitions: Divorce, job loss, or relocation.
• Health challenges: Chronic illness or disability.
• Financial stress: Economic hardship or debt.
• Interpersonal conflicts: Family disputes or workplace tension.

These stressors can trigger symptoms, particularly in individuals with limited coping mechanisms or support systems.

A Brief History of Adjustment Disorder

The concept of adjustment disorder has evolved over time:

• 1952 (DSM-I): Introduced as “transient situational personality disorder,” despite not being a personality disorder.
• 1968 (DSM-II): Renamed “transient situational disturbances.”
• 1980 (DSM-III): Officially classified as adjustment disorder.
• 1994 (DSM-IV): Introduced subtypes, including mixed anxiety and depressed mood.
• 2013 (DSM-5): Moved to the trauma and stressor-related disorders category, with no major changes to criteria.

This historical context highlights the growing recognition of adjustment disorder as a distinct mental health condition.

Subtypes of Adjustment Disorder

Adjustment disorder has six specifiers, each reflecting different symptom presentations:

The F43.23 specifier is particularly common, reflecting the overlap of anxiety and depression in response to stressors.

Common Stressors Linked to F43.23

Adjustment disorder can stem from various life events, including:

• Personal conflicts: Arguments with family or friends.
• Work-related stress: Job loss, workplace disputes, or overwhelming responsibilities.
• Health issues: Diagnosis of a chronic illness or disability.
• Financial strain: Debt, unemployment, or unexpected expenses.
• Major life changes: Divorce, relocation, or loss of a loved one.

These stressors can vary in intensity but share the potential to disrupt emotional and behavioral stability.

Treatment Strategies for Adjustment Disorder

Creating an effective treatment plan for F43.23 focuses on reducing symptoms and building coping skills. Key components include:

1. Psychotherapy:

   • Cognitive Behavioral Therapy (CBT): Helps individuals reframe negative thoughts and develop coping strategies.
   • Interpersonal Therapy (IPT): Addresses relationship challenges tied to the stressor.
   • Solution-Focused Brief Therapy (SFBT): Targets specific goals to manage immediate distress.

1. Stress Management Techniques:

   • Mindfulness and relaxation exercises.
   • Journaling to process emotions.
   • Time management to reduce overwhelm.

1. Support Systems:

   • Encouraging connections with family, friends, or support groups.
   • Building resilience through social engagement.

1. Medication (if necessary):

   • Short-term use of anti-anxiety or antidepressant medications may be considered for severe symptoms.

Using AI Tools for Treatment Planning

Tools like S10.AI, a HIPAA-compliant AI platform, can streamline treatment planning by generating progress notes, SMART treatment plans, and session analytics. These tools save clinicians time while ensuring accurate, insurance-compliant documentation for F43.23 cases. Learn more about S10.AI.

Billing Tips for F43.23

When billing for adjustment disorder with mixed anxiety and depressed mood, consider these best practices:

• Verify Diagnosis: Ensure the client’s symptoms do not meet criteria for another mental health disorder, such as MDD or PTSD.
• Monitor Duration: Symptoms persisting beyond six months may indicate a different diagnosis.
• Exclude Grief: Normal grief responses do not qualify for F43.23.
• Assess Normalcy: Nonpathological reactions to stress should not be coded as adjustment disorder.

Accurate billing with F43.23 supports effective treatment planning and improves patient outcomes.

Frequently Asked Questions (FAQ)

What is ICD-10-CM code F43.23?

The F43.23 code represents adjustment disorder with mixed anxiety and depressed mood, a condition triggered by a stressor causing emotional and behavioral distress.

How is adjustment disorder different from depression or anxiety?

Unlike depression or anxiety disorders, adjustment disorder is directly linked to a specific stressor and typically resolves within six months with proper intervention.

What are common treatments for F43.23?

Treatments include psychotherapy (e.g., CBT, IPT), stress management techniques, and, in some cases, short-term medication to manage symptoms.

How do you accurately document F43.23 when a patient's symptoms of anxiety and depression are a direct reaction to a recent life event?

For the 2025 ICD-10-CM code F43.23, Adjustment Disorder with Mixed Anxiety and Depressed Mood, your documentation must clearly link the onset of symptoms to an identifiable stressor. Best practices include noting the specific stressor (e.g., job loss, divorce), the timeline (symptoms within three months of the stressor), and the mixed presentation of both anxiety (worry, nervousness) and depressive (low mood, anhedonia) symptoms that are clinically significant but do not meet the criteria for a major depressive or anxiety disorder. Consider implementing AI scribes to automatically capture and structure these crucial details during the patient encounter, ensuring your documentation for F43.23 is always audit-proof and compliant.

What is the best way to differentiate F43.23 from F41.9 (Anxiety Disorder, Unspecified) or F32.9 (Major Depressive Disorder, Single Episode, Unspecified) in clinical notes?

The key to differentiating F43.23 lies in documenting the direct temporal relationship to a specific psychosocial stressor and establishing that the symptoms do not meet the full criteria for another disorder like MDD or GAD. Your notes should specify that the emotional/behavioral symptoms are a maladaptive response to the stressor and would likely remit if the stressor were removed. Explore how AI-powered documentation tools can help parse patient narratives for these specific diagnostic criteria, making it easier to select the most accurate code and avoid common diagnostic ambiguities.

Can I bill F43.23 if the patient denies classic depression but shows clear signs of distress and anxiety after a setback?

Yes, you can still diagnose F43.23, Adjustment Disorder with Mixed Anxiety and Depressed Mood, even with patient denial, provided your clinical assessment supports it. Document the observable signs of distress, such as tearfulness, hopelessness, and worry, alongside the identifiable stressor. Your clinical judgment is key. Using an AI scribe can help you capture the nuanced, verbatim patient language and your objective observations in real-time, providing robust support for your diagnostic conclusion when billing for F43.23.

For F43.23, what are the documentation requirements for billing both psychotherapy and medication management (E/M) codes like 99214 + 90833?

When billing for both services with an F43.23 diagnosis, your documentation must distinctly support both the E/M component (medication management, assessment of physical symptoms) and the psychotherapy add-on code. You must record the time spent on psychotherapy separately and ensure your notes detail the therapeutic intervention, the patient's response, and the plan for ongoing care. The best way to automate documentation is to use an AI scribe that can intelligently separate and format the distinct elements of the visit, simplifying complex billing scenarios.

Do AI scribes replace human scribes for documenting diagnoses like F43.23?

AI scribes are not intended to replace human scribes but rather to augment clinical teams by handling the complex task of medical documentation. For a diagnosis like F43.23, an AI scribe can instantly transcribe the patient encounter, extract relevant details (stressors, symptom timelines, mixed emotional states), and pre-populate the EHR. This frees up both clinicians and human scribes to focus on higher-value, patient-facing tasks. Learn more about how AI scribes can integrate into and enhance your current workflow.

What are the common pitfalls when using the F43.23 code and how can technology help avoid them?

A common pitfall is insufficient documentation linking the symptoms to the stressor, or using F43.23 when a more severe diagnosis like PTSD or Major Depressive Disorder is more appropriate. Another issue is using the code for symptoms that persist more than six months after the stressor has terminated. AI-driven clinical documentation tools can mitigate these risks by prompting for necessary details based on ICD-10 criteria and providing alerts for potential coding inconsistencies, thereby improving diagnostic and billing accuracy.

How specific must the stressor be in the documentation for an F43.23 diagnosis to be considered valid for reimbursement?

The stressor must be an identifiable, significant life event or change; it cannot be a vague or non-specific complaint. Your note should clearly state the nature of the stressor (e.g., "patient lost their job of 10 years," "patient is undergoing a contentious divorce"). The more specific the documentation, the stronger the justification for the F43.23 diagnosis. Consider implementing AI documentation solutions that are designed to capture and highlight these specific data points from the patient conversation, strengthening your claim for reimbursement.

How do AI scribes handle the nuances of patient-reported symptoms for F43.23, especially in telehealth appointments?

Advanced AI scribes are designed to accurately capture and transcribe natural conversation from both in-person and telehealth appointments. They can identify and differentiate between patient-reported symptoms of anxiety (e.g., "I can't stop worrying") and depression (e.g., "I don't enjoy anything anymore"), which is crucial for the "mixed" specifier in F43.23. This ensures that your documentation is rich with the specific details needed for accurate coding, regardless of the consultation format.

What's the best way to track symptom duration for F43.23 to ensure it doesn't evolve into a chronic condition requiring a different code?

Consistently documenting the onset of symptoms relative to the stressor at each visit is the best practice. Your notes should create a clear timeline. An AI scribe can automate this process by tracking mentions of the stressor and symptoms across multiple encounters, making it easy to see if the condition resolves within the expected six-month timeframe post-stressor or if it's evolving into a condition that requires re-evaluation and a different ICD-10 code.

Is there a risk of "upcoding" or "downcoding" with F43.23, and how can I ensure my coding is accurate?

Yes, there is a risk. Downcoding might occur if you use F43.23 when a more severe condition like PTSD is present, while upcoding could happen if the symptoms don't cause clinically significant distress. Accuracy comes from detailed documentation that justifies the code. AI-powered clinical coding assistants can analyze your notes and suggest the most appropriate ICD-10 code based on the documented evidence, reducing compliance risks and ensuring you code with confidence. Explore how these tools can support your clinical decision-making.

What is ICD-10 Code F43.23 and when is it used in a discharge summary?

The ICD-10 code F43.23 is used for "Adjustment Disorder with Mixed Anxiety and Depressed Mood." This diagnosis is appropriate for patients who develop emotional or behavioral symptoms, including a combination of anxiety and depression, in response to an identifiable stressor. In a discharge summary, F43.23 is used to document this specific type of adjustment disorder, which is crucial for accurate medical records, continuity of care, and proper billing. The stressor could be a single event, like a job loss, or a series of events.

How can clinicians efficiently document the criteria for F43.23 in discharge summaries?

To efficiently document F43.23, clinicians must clearly link the patient's symptoms of mixed anxiety and depression to a specific life stressor. This requires detailed notes on the nature of the stressor, the timeline of symptom onset (within three months of the stressor), and the severity of the functional impairment. S10.AI’s AI scribe tools can help streamline this process by capturing the full patient narrative during the encounter, ensuring that all essential details for the diagnosis are accurately transcribed and organized in the discharge summary. This saves clinicians valuable time and reduces the risk of documentation gaps.

What are the key differences between F43.23 and other mood disorders in a discharge summary?

It is critical to differentiate F43.23 from other mood disorders like Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD) in a discharge summary. The key distinction is that the symptoms in F43.23 are a direct reaction to a specific stressor and typically resolve within six months of the stressor's removal. In contrast, MDD and GAD may not be linked to a specific event and have different diagnostic criteria regarding duration and severity of symptoms. Accurate differentiation is essential for appropriate treatment planning and billing.

What are the essential elements to include in a discharge summary for a patient with F43.23?

A comprehensive discharge summary for a patient with F43.23 should include:

• The specific stressor(s) that triggered the adjustment disorder.

• A detailed description of the mixed anxiety and depressive symptoms, including their severity and impact on the patient's daily functioning.

• The timeline of symptom onset and duration.

• A clear record of the treatment provided, including psychotherapy, medication, and other interventions.

• A plan for follow-up care, including any referrals to mental health specialists.

S10.AI’s AI scribe can help ensure all these elements are captured and clearly documented, creating a complete and compliant discharge summary.

How can using an AI scribe like S10.AI improve the quality and efficiency of creating discharge summaries for F43.23?

Using an AI scribe like S10.AI can significantly improve the quality and efficiency of creating discharge summaries for F43.23 in several ways:

• Improved Accuracy: The AI scribe captures the entire patient encounter, ensuring that all relevant details about the stressor, symptoms, and treatment plan are accurately documented.

• Time Savings: It automates the transcription and documentation process, freeing up clinicians to focus on patient care rather than administrative tasks.

• Enhanced Compliance: By ensuring all necessary components of the diagnosis are included, the AI scribe helps create discharge summaries that are compliant with billing and regulatory requirements.

• Better Continuity of Care: A clear and comprehensive discharge summary facilitates a smoother transition of care to the patient's primary care physician or mental health provider.

By leveraging S10.AI, healthcare organizations can streamline their discharge summary workflow, improve clinician satisfaction, and ensure the highest quality of care for patients with adjustment disorders.

The Bottom Line

Adjustment disorder with mixed anxiety and depressed mood (F43.23) is a common yet treatable mental health condition triggered by significant life stressors. By understanding its symptoms, diagnostic criteria, and treatment options, clinicians can provide targeted care to help clients regain balance. Tools like S10.AI can enhance efficiency in documentation and treatment planning, ensuring better outcomes for those navigating this condition.

External Resources

• DSM-5 Overview – American Psychiatric Association
• ICD-10-CM Guidelines – Centers for Disease Control and Prevention
• S10.AI for AI-Powered Documentation – Streamline your practice with HIPAA-compliant tools