ICD Coding for Treatment-Resistant Depression
No, there is no specific ICD-10 code for treatment-resistant depression (TRD). TRD is diagnosed clinically through documentation of treatment history rather than through a distinct diagnostic code.
Clinical Diagnosis vs. Coding Reality
The International Classification of Diseases is referenced as one method for diagnosing major depressive disorder, but TRD itself lacks a dedicated code 1. Instead, you must:
- Use the standard major depressive disorder ICD-10 codes (such as F32.x or F33.x depending on single vs. recurrent episode) 1
- Document treatment resistance through clinical history rather than coding 1
How to Establish TRD Diagnosis for Documentation
Since coding won't capture TRD status, establish the diagnosis through:
Minimum Criteria Required
- At least two failed adequate antidepressant trials with different mechanisms of action in the current episode 2, 3
- Each trial must be at minimum effective dosage for ≥4 weeks duration 2, 3, 4
- Discontinuation due to side effects before 4 weeks does not count as treatment failure 2, 3
Preferred Documentation Method
Use the Maudsley Staging Method (MSM) for structured documentation 3. This is the only staging tool with prospective validation and correctly predicts treatment resistance in >85% of cases 1, 3. The MSM uniquely incorporates:
- Number of treatment failures 1
- Duration of illness 1
- Baseline symptom severity 1
- Augmentation strategies attempted 1
- ECT treatment history 1
Alternative Documentation Tools
If MSM is not feasible, other options include 1:
- Antidepressant Treatment History Form (ATHF) - has good reliability and predictive validity for ECT studies 1
- Careful clinical history documenting number, dose, duration, and adherence of prior trials 1
Critical Documentation Elements
Before confirming TRD, document these six confounders 4:
- Depressive severity at baseline 4
- Duration of current episode 4
- Prior treatment intolerance 4
- Prior augmentation/combination therapy attempts 4
- Prior psychotherapy trials 4
- Psychiatric comorbidities (especially substance use and personality disorders) 4
Common Pitfall
Do not count treatment failures from >2 years ago for prolonged episodes 3. Only recent treatment failures within the last 2 years should establish TRD diagnosis 3.