Pediatric Coding Alert

Question: How do you code a patient who has depression and anxiety? Do you code the two conditions separately? Or can you use F41.8?

Also, when two conditions like anxiety and depression are coded together with one code, can they be counted as two or more stable chronic illnesses in the number and complexity of problems addressed at the encounter element of medical decision making (MDM)?

AAPC Forum Participant

Answer: According to the AHA ICD-10-CM Coding Clinic (2021, Volume 8, Number 1), depression and anxiety are not automatically linked. This means you should assign separate codes to the two conditions unless your pediatrician has documented that they are connected. So, the Coding Clinic recommends you use codes such as F32.9 (Major depressive disorder, single episode, unspecified) and F41.9 (Anxiety disorder, unspecified) “when the documentation has not established a linkage between the depression and the anxiety.”

However, the article goes on to tell you it would be appropriate to use F41.8 (Other specified anxiety disorders) when “the provider does indicate a relationship between the two conditions.” That’s because ICD-10 lists anxiety depression (mild or not persistent) and mixed anxiety and depressive disorder as synonyms for the code.

So, this would be a good time to query your pediatrician concerning the specificity of both the relationship as well as type. And if the pediatrician notes “a linkage in the documentation to indicate a single disorder” and that the linkage is “a distinct clinical diagnosis” such as mixed anxiety and depressive order, or MADD, per the Coding Clinic, it would be appropriate to use F41.8.

As for counting the conditions for MDM purposes, even though anxiety and depression are coded to one ICD-10 code you should regard them as two separate conditions. They may be related, but each one has its own characteristics and may need separate testing to diagnose or separate prescription drugs for management. So, you should be able to assign a moderate level of MDM to the number and complexity of problems addressed element based on the patient having one or more chronic illnesses with exacerbation, progression, or side effect of treatment, or two or more stable chronic illnesses depending on the circumstances at the time of the encounter.