Mood Disorder ICD-10: Family Table for Charts

It’s 5:40 on a Friday. Jordan’s intake is done. PHQ-9 is 14. He said he has been down for years. The claim line still shows last year’s F32.9 because that is what the template dropped in. You still have not asked about hypomania, a prior episode with relief, or whether this is two weeks or two years.

Pick the mood disorder ICD-10 family before you touch a fifth character. A score of 14 does not mean F32.1. “Down for years” does not mean F33. Work the family gate, then recode the unspecified lines on a short clock.

If you still need codes outside F30-F39, start with ICD-10 codes for therapists.

Educational content, not clinical or legal advice. ICD-10-CM descriptors, DSM criteria, payer rules, and state scope change. Check current files before you diagnose, code, or bill.

Use official code sources first

Use the CDC ICD-10-CM page for official US diagnosis-code files and guideline updates. Use the CMS ICD-10 page for Medicare coding resources. The American Psychiatric Association DSM overview is the source for the diagnostic framework the codes represent.

Those files do not replace payer policy or your license. They keep you from coding from memory, last year’s template, or a one-line internet list.

Mood disorder ICD-10 family table

F30, F31, F32, F33, and F34 are categories. The billable line is a more specific code. Read the official descriptor, then write the evidence next to it.

Category	Official ICD-10-CM title	Use when the chart supports
F30	Manic episode	A current manic episode without a bipolar history. F30 itself is not billable.
F31	Bipolar disorder	Bipolar I or II, including current episode, severity, psychotic features, and remission codes.
F32	Depressive episode	A first major depressive episode, plus F32.81, F32.89, and F32.A when those descriptors fit.
F33	Major depressive disorder, recurrent	At least one prior major depressive episode, then current severity or remission.
F34	Persistent mood [affective] disorders	Cyclothymia (F34.0), dysthymia (F34.1), DMDD (F34.81), or other persistent patterns.
F39	Unspecified mood [affective] disorder	A mood disturbance is supported, and no more specific family is defensible yet.

ICD-10-CM does not carry an F38 “other mood disorder” category. If an old WHO table still shows F38, ignore it for US claims.

The code is the index entry. The chart still has to show why that family fits this client today.

Codes therapists actually bill

Most outpatient notes land in a short list. Keep the official descriptor, then write what you heard and observed.

Code	ICD-10-CM descriptor	Use when the chart supports
F32.9	Major depressive disorder, single episode, unspecified	First-episode MDD is supported; severity is not yet specified. Plan an early recode.
F32.0	Major depressive disorder, single episode, mild	First episode, mild symptom load and impairment.
F32.1	Major depressive disorder, single episode, moderate	First episode, moderate symptoms and functional impact.
F32.2	Major depressive disorder, single episode, severe without psychotic features	First episode, severe impairment without psychosis.
F32.3	Major depressive disorder, single episode, severe with psychotic features	First episode with mood-congruent or mood-incongruent psychosis. Coordinate care.
F32.A	Depression, unspecified	Depressive symptoms are present; MDD criteria are not yet established.
F32.81	Premenstrual dysphoric disorder	PMDD criteria are met. Do not use this as a stand-in for PMS.
F33.1	Major depressive disorder, recurrent, moderate	Prior episode plus current moderate severity.
F33.0	Major depressive disorder, recurrent, mild	Recurrent course, mild current episode.
F33.2	Major depressive disorder, recurrent, severe without psychotic features	Recurrent course, severe current episode without psychosis.
F33.9	Major depressive disorder, recurrent, unspecified	Recurrent MDD is supported; current severity is not yet specified.
F34.1	Dysthymic disorder	Persistent low-grade depression meeting duration and associated-symptom rules.
F34.0	Cyclothymic disorder	Chronic hypomanic and depressive swings that never meet full mania or MDD.
F34.81	Disruptive mood dysregulation disorder	Childhood or adolescent presentation with severe temper outbursts and persistent irritability.
F31.81	Bipolar II disorder	At least one hypomanic episode and one major depressive episode, without a manic episode.
F31.32	Bipolar disorder, current episode depressed, moderate	Bipolar I, current moderate depression.
F31.9	Bipolar disorder, unspecified	Bipolar spectrum is supported; type or current episode is not yet specified.
F39	Unspecified mood [affective] disorder	Mood disturbance only; family still open.

If two distinct disorders are both supported, both codes can be carried, with the focus of treatment listed first. Do not stack F39 on top of a better-supported F32 or F33 line to “acknowledge mood.”

Start with the family gate

Do not pick F32.1 from a PHQ-9 of 14. Work the family checks first.

1. Name the organizing problem. Is the disturbance primarily mood, or is mood secondary to trauma, anxiety, substance use, ADHD, or a medical condition?
2. Screen for lifetime mania and hypomania. One supported hypomanic episode moves the family to F31, even if today’s visit is depression.
3. Separate a first episode from a recurrent course. Prior sadness is not a prior major depressive episode. Ask duration, symptom count, impairment, and whether there was a period of relief.
4. Time the current picture. Two weeks is the usual MDD duration floor. Two years is the usual adult dysthymia floor. A stressor inside three months opens the adjustment disorder ICD-10 branch.
5. Show clinical significance. Name work, school, relationships, sleep, self-care, or daily responsibilities in observable terms.
6. Pressure-test psychosis, mixed features, and risk. Severe codes and safety planning need that evidence in the same note.
7. Set a recode clock for unspecified lines. F32.9, F32.A, F33.9, F31.9, and F39 should name the next evidence step.

If those gates fail, stop. An anxiety, trauma-related, adjustment, substance, or medical code may be the honest line.

Dana, an LPC closing Friday claims, ran this on Jordan. Hypomania screen negative. No clear prior episode with relief. Two-week window and five-symptom count were not yet in the note. She left F32.A, not F32.9, and wrote a recode date at session four.

F32.9 versus F32.A

These two codes get swapped more than any other pair in this block.

F32.9 means you can already defend a major depressive episode: the two-week window, the five-symptom count with depressed mood or anhedonia as an anchor, impairment, and a substance or medical review. What is missing is severity. The plan then names how severity will be specified: a PHQ-9 trajectory, a fuller functional review, collateral, or a scheduled recode, often within three to four sessions.

F32.A means the chart supports depression as a presenting problem and does not yet support MDD. Low mood for ten days, two symptoms, or an incomplete history belongs here, not on F32.9. F32.A is still a short-clock code. It is not a quieter way to bill MDD.

F39 is broader still. Use it when you cannot even defend “depression” versus “mania” versus “mixed mood.” If the client is clearly depressed and the only open question is MDD versus not-yet-MDD, F32.A is more specific than F39.

Single episode, recurrent, or persistent

F32 versus F33 is a history question. The current episode can look identical.

A defensible recurrent code names at least one earlier episode that plausibly met MDD criteria, then a period when those criteria were not met. “Chronic depression” is not automatically F33. If the low mood has been continuous for years without a clear episode structure, F34.1 may fit better than a recurrent specifier you cannot evidence.

F34.1 still needs associated symptoms, impairment, and the duration rule. In adults that is typically two years. In children and adolescents the duration floor is shorter. If a major depressive episode is sitting on top of dysthymia, document the superimposed episode and sequence the focus of care.

F32.81 is not a mood-family shortcut for any premenstrual complaint. Keep it for a PMDD formulation.

If the client is a child with severe temper outbursts and persistent irritability, look at F34.81 rather than stretching an adult F33 line.

Severity, psychosis, and remission

Once the family is right, the next character is a severity or course call, not a score call.

Mild, moderate, and severe should match symptom load and impairment together. A PHQ-9 in the 10 to 14 range often supports moderate, and a score at or above 20 often supports severe, but the score is not the diagnosis. Write the function: missed shifts, stalled self-care, stalled decisions, or collapsed sleep.

Psychotic-feature codes (F32.3, F33.3, F31.2, F31.5, and related lines) need hallucinations, delusions, or other psychotic symptoms in the record, plus a plan for psychiatric collaboration. Notes that say “severe” because the client is crying hard do not support those codes.

Remission codes belong when the episode criteria are no longer met, in part or in full. Do not recode to remission because the client had one better week.

The bipolar gate therapists miss

A mood disorder ICD-10 chart that never asks about elevated or irritable mood, decreased need for sleep, racing thoughts, or impulsive spending will over-assign F32 and F33.

F30 is for a manic episode without a bipolar history. F31 is the bipolar family, including F31.81 bipolar II. If today’s presentation is depression but the history supports hypomania, the claim line is still F31, not F33.

F34.0 cyclothymia is the chronic, subthreshold swing pattern. F34.81 DMDD is a child and adolescent diagnosis built on severe temper outbursts and persistent irritability, not an adult “mood swings” label.

When mania, mixed features, or psychosis is in play, document risk, sleep, substances, and the referral or collaboration step in the same note.

For how DSM language maps onto claim codes without collapsing the two systems, use the DSM-5 to ICD-10 crosswalk.

Adjacent diagnoses the chart has to name

A low-mood week can sit next to several other codes. Name the fork in the note.

Adjustment disorder with depressed mood is F43.21 when an identifiable stressor, the three-month onset window, and the adjustment-disorder gate fit, and full MDD does not. A stressor does not demote MDD to adjustment disorder.

Generalized anxiety disorder is F41.1 when worry is broad, hard to control, and has its own duration and associated symptoms. The anxiety ICD-10 codes guide holds that table. Anxious distress as a depressive specifier is not the same as a second primary anxiety diagnosis.

Post-traumatic stress disorder lives in F43.1. Numbness, sleep disruption, and anhedonia after a Criterion A event are not automatically a mood-family code.

Substance, medication, and medical contributors can mimic energy change, irritability, or sleep collapse. Document the review even when the conclusion is brief.

Documentation crosswalk

Mood disorder ICD-10 codes hold up better when the note answers the reviewer’s basic questions before the claim leaves the practice.

Chart element	What to document	Why it matters
Mood pattern	Depressed mood, anhedonia, elevated or irritable mood, mixed features, or persistent low-grade mood	Selects the family.
Episode history	First episode, prior episodes with relief in between, or a continuous persistent course	Selects F32, F33, or F34.
Symptom count and duration	Two-week MDD window, two-year adult dysthymia window, or mania/hypomania duration	Supports the descriptor.
Functional impairment	Missed work, school drop-off, relationship strain, sleep collapse, reduced self-care, or stalled decisions	Supports medical necessity.
Severity or course	Mild, moderate, severe, psychotic features, partial remission, full remission, or unspecified	Selects the next character.
Differential reasoning	Bipolar spectrum, adjustment disorder, PTSD, GAD, substance, medication, thyroid or other medical contributors	Shows you considered likely alternatives.
Risk and safety	Suicidal ideation, self-harm, reckless mania, aggression, or care avoidance	Documents acuity and treatment intensity.
Treatment-plan link	Behavioral activation, cognitive work, sleep routine, interpersonal repair, safety planning, or referral	Connects the code to active care.

A concise note can still be strong. It names the pattern, the impairment, the intervention, the client response, and the plan.

Treatment-plan and medical-necessity language

A diagnosis code does not prove medical necessity by itself. The treatment record does that work.

For mood-family care, the plan usually ties the code to near-term functional targets: restore a morning routine, resume two avoided activities, reduce missed workdays, complete a sleep window, or bring PHQ-9 below an agreed range. Unspecified codes belong in the plan as a review date, not as a permanent label.

The progress note then carries the same thread: intervention, response, homework, risk changes, and the next clinical step. If the picture widens into hypomania, psychosis, or a trauma-led formulation, the note should say whether the family still fits.

Emosapien can keep that thread in one clinician-reviewed draft. The AI clinical notes workflow structures intake and progress language while you edit, approve, and decide what enters the record.

Mood disorder ICD-10 workflow for the chart

1. Start with the clinical presentation, not the code list.
2. Screen mania, hypomania, psychosis, substances, medical contributors, trauma, and risk.
3. Confirm the family gate before any severity character.
4. Pick the most specific supported code in F30-F39.
5. Link the code to treatment-plan targets and a review date.
6. Carry the same thread into each progress note.
7. Recode unspecified or catch-all labels as the evidence changes, or document why they still fit.