Excludes1 pair

F20- vs F33.3

F20 and F33.3 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.

The official note, declared on F20
mood [affective] disorders with psychotic symptoms (F30.2, F31.2, F31.5, F31.64, F32.3, F33.3)
F20

Schizophrenia

Not billable
Chapter 5
Mental, Behavioral and Neurodevelopmental disorders
Section
F20-F29
F33.3

Major depressive disorder, recurrent, severe with psychotic symptoms

Billable
Chapter 5
Mental, Behavioral and Neurodevelopmental disorders
Section
F30-F39
Use when the record says
  • Endogenous depression with psychotic symptoms
  • Major depressive disorder, recurrent, with psychotic features
  • Recurrent severe episodes of major depression with mood-congruent psychotic symptoms
  • Recurrent severe episodes of major depression with mood-incongruent psychotic symptoms
  • Recurrent severe episodes of major depression with psychotic symptoms
  • Recurrent severe episodes of psychogenic depressive psychosis
  • Recurrent severe episodes of psychotic depression
  • Recurrent severe episodes of reactive depressive psychosis
Indexed under
  • Depression › endogenous › with psychotic symptoms
  • Depression › psychotic › recurrent
  • Depression › vital › with psychotic symptoms
  • Psychosis, psychotic › reactive › depressive › recurrent
  • Disorder › depressive › major › recurrent › with psychotic features

Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027