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Family Practice Coding Alert

You Be the Coder:

Ponder Depression, Anxiety Coding Options

Question: A family physician treats a patient for depression in the office. Which CPT and ICD-9 codes should I report?

Louisiana Subscriber

Answer: Depending on the nature of the visit, you should assign either an office visit code (99201-99215, Office or other outpatient visit for the evaluation and management of a new or established patient) or a psychiatry code (90801-90899). If the FP provides a primarily medical-based service, you should submit the appropriate-level E/M code. But if the service involves psychotherapy or other psychiatric services, select the appropriate psychiatry code, such as 90801 (Psychiatric diagnostic interview examination).

You should use the diagnosis code that describes the nature of the patient's depression. If this is the patient's first episode of acute depression, assign 296.2x (Major depressive disorder, single episode). For a recurrent episode, submit 296.3x (Major depressive disorder, recurrent episode). Select the fifth digit, such as 2 for -moderate,- based on the severity of the patient's disorder.

Example: An FP treats a patient for moderate depression. The history of present illness (HPI) indicates the patient has had episodes in the past. You should report 296.32 to indicate a recurrent depressive episode of moderate severity.

If the patient is having anxiety due to recent catastrophic stress, such as losing a house and/or relatives due to Hurricane Katrina, look at category 308.x (Acute reaction to stress). Other types of depression you may consider include:

- neurotic depression--300.4 (Dysthymic disorder)

- postpartum depression--648.4x (Other current conditions in the mother classifiable elsewhere, but complicating pregnancy, childbirth, or the puerperium; mental disorders). When the FP cannot classify the depression or does not specify the type, report 311 (Depressive disorder, not elsewhere classified), which includes -depression NOS.-