Understanding Depression with Psychotic Features, also known as Major Depression with Psychotic Features or Psychotic Depression, is crucial for accurate clinical documentation and medical coding. This page provides information on diagnosis, symptoms, and treatment of Psychotic Depression, supporting healthcare professionals in proper documentation and coding practices related to Major Depressive Disorder with Psychotic Features. Learn about the diagnostic criteria for Depression with Psychotic Features to ensure accurate and comprehensive healthcare records.
Also known as
Major depressive disorder
Characterized by persistent sadness, loss of interest, and other symptoms.
Mood affective disorders
Encompasses various disorders affecting mood, including depression and mania.
Mental, Behavioral and Neurodevelopmental disorders
Includes a wide range of mental and behavioral conditions.
Follow this step-by-step guide to choose the correct ICD-10 code.
Is the patient's primary diagnosis Depression?
Yes
Does the depression meet criteria for Major Depressive Episode?
No
Do not code for depression. Explore and code the actual primary diagnosis.
When to use each related code
| Description |
|---|
| Depression with psychosis |
| Major Depressive Disorder |
| Schizoaffective Disorder |
Coding requires specific documentation of the psychosis type (e.g., mood-congruent, mood-incongruent) for accurate code assignment.
Anxiety, substance use, or personality disorders are frequently present but may be overlooked, impacting risk adjustment and reimbursement.
Vague descriptions of psychotic features (e.g., 'delusions') without detailed content hinder proper coding and can trigger audits.
Q: How can I differentiate between Depression with Psychotic Features and Schizophrenia in a clinical setting?
A: Differentiating between Depression with Psychotic Features and Schizophrenia can be challenging due to overlapping symptoms like delusions or hallucinations. However, in Depression with Psychotic Features, the psychotic symptoms are typically mood-congruent, meaning they align with the depressive themes (e.g., delusions of worthlessness or guilt). In Schizophrenia, psychotic symptoms are often mood-incongruent and more bizarre in nature. Additionally, the depressive symptoms in Depression with Psychotic Features are prominent and central to the presentation, whereas negative symptoms like flat affect and avolition are more characteristic of Schizophrenia. A thorough assessment of symptom onset, duration, and relationship to mood changes is crucial for accurate diagnosis. Explore how a detailed patient history and standardized assessment tools can aid in differential diagnosis and inform treatment decisions.
Q: What are the most effective evidence-based treatment strategies for managing a patient with Major Depression with Psychotic Features?
A: Evidence-based treatment for Major Depression with Psychotic Features typically involves a combination of antidepressant medication and antipsychotic medication. Electroconvulsive therapy (ECT) is also considered a first-line treatment option, especially in severe cases or when rapid response is needed. Antidepressant monotherapy is generally not recommended due to the risk of exacerbating psychotic symptoms. When choosing an antipsychotic, consider agents with a lower risk of metabolic side effects, particularly in patients with pre-existing risk factors. Learn more about the comparative efficacy and safety profiles of different antipsychotics in the context of Psychotic Depression to tailor treatment to individual patient needs.
Patient presents with a primary diagnosis of Major Depressive Disorder with Psychotic Features, also known as Psychotic Depression. The patient meets DSM-5 criteria for a major depressive episode, exhibiting symptoms including depressed mood, anhedonia, significant weight loss, insomnia, psychomotor retardation, fatigue, feelings of worthlessness, diminished concentration, and recurrent thoughts of death. In addition to these core depressive symptoms, the patient experiences congruent psychotic features, specifically auditory hallucinations consistent with depressive themes of guilt and worthlessness. These hallucinations are not attributable to the physiological effects of a substance or another medical condition. The patient denies command hallucinations or visual hallucinations. Differential diagnoses considered included Major Depressive Disorder without psychotic features, Schizoaffective Disorder, and Bipolar Disorder with Psychotic Features. These were ruled out based on the patient's history, symptom presentation, and absence of manic or hypomanic episodes. Assessment of suicide risk indicates moderate risk due to passive suicidal ideation without a specific plan. The patient's current medication regimen includes initiation of aripiprazole for the psychotic features and sertraline for the depressive symptoms. Treatment plan includes psychotherapy, specifically Cognitive Behavioral Therapy (CBT) focused on depression management and coping skills, combined with pharmacotherapy. Patient education regarding medication adherence, symptom management, and early warning signs of relapse was provided. Prognosis is guardedly optimistic with continued treatment and close monitoring. Follow-up appointment scheduled in two weeks to assess response to medication and psychotherapy. ICD-10 code F32.3 is documented for Major Depressive Disorder, recurrent, severe, with psychotic features. CPT codes for psychotherapy and medication management will be documented accordingly.