F22 vs F32.3
F22 and F32.3 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.
F22
Delusional disorders
Billable
- Chapter 5
- Mental, Behavioral and Neurodevelopmental disorders
- Section
- F20-F29
Use when the record says
- Delusional dysmorphophobia
- Involutional paranoid state
- Paranoia
- Paranoia querulans
- Paranoid psychosis
- Paranoid state
- Paraphrenia (late)
- Sensitiver Beziehungswahn
Indexed under
- Cotard's syndrome
- Lycanthropy
- Paranoia (querulans)
- Paraphrenia, paraphrenic (late)
- Sander's disease (paranoia)
F32.3
Major depressive disorder, single episode, severe with psychotic features
Billable
- Chapter 5
- Mental, Behavioral and Neurodevelopmental disorders
- Section
- F30-F39
Use when the record says
- Single episode of major depression with mood-congruent psychotic symptoms
- Single episode of major depression with mood-incongruent psychotic symptoms
- Single episode of major depression with psychotic symptoms
- Single episode of psychogenic depressive psychosis
- Single episode of psychotic depression
- Single episode of reactive depressive psychosis
Indexed under
- Depression › psychotic (acute) (mental)
- Melancholia › reactive
- Depression › major › with psychotic symptoms (acute) (mental)
- Depression › reactive › psychotic (acute) (mental)
- Psychosis, psychotic › psychogenic › depressive
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