What is the ICD 10 code for depression related to a recent death of a spouse?

ICD-10 Code for Depression Related to Recent Death of Spouse

The appropriate ICD-10 code is F32 or F33 (depending on whether this is a single or recurrent episode), NOT a bereavement-specific code, if the patient meets full diagnostic criteria for major depressive disorder. 1, 2

Understanding the Diagnostic Framework

The ICD-10 classification system does not have a separate code specifically for "depression related to death of spouse." Instead, you must determine whether the patient meets criteria for a depressive episode and code accordingly 1, 3:

• F32: Depressive episode (single episode)
• F33: Recurrent depressive disorder (if history of prior episodes)
• F34.1: Dysthymic disorder (if chronic, lower-grade symptoms)

Critical Distinction: Normal Grief vs. Major Depression

The ICD-11 approach (which clarifies ICD-10 intent) explicitly states that bereavement raises the diagnostic threshold for depression, but does not exclude the diagnosis. 2 This is a crucial clinical distinction that differs from DSM-5.

When to Diagnose Depression in Bereaved Patients

A depressive episode during bereavement is suggested by 2:

• Persistence of symptoms for at least one month beyond what is culturally normative
• Presence of at least one symptom unlikely in normal grief:
  • Extreme beliefs of low self-worth or guilt NOT related to the deceased
  • Psychotic symptoms
  • Suicidal ideation
  • Psychomotor retardation

When NOT to Diagnose Depression

Do not code as depression if symptoms are consistent with normative grief responses within the individual's religious and cultural context. 2 Normal bereavement does not require a mental disorder diagnosis.

Diagnostic Algorithm for This Clinical Scenario

Step 1: Screen with PHQ-9

Administer the full PHQ-9 to quantify symptom severity 4, 5, 6:

• Score 1-7: Minimal symptoms (likely normal grief)
• Score 8-14: Moderate symptoms (requires diagnostic evaluation)
• Score 15-27: Severe symptoms (requires immediate psychiatric referral)

Step 2: Assess for Major Depressive Episode Criteria

Requires at least 5 symptoms present for ≥2 weeks, with at least one being depressed mood OR anhedonia 4, 2:

1. Depressed mood
2. Anhedonia (loss of interest/pleasure)
3. Sleep disturbance
4. Low energy/fatigue
5. Appetite changes
6. Low self-worth/guilt
7. Concentration difficulties
8. Psychomotor changes
9. Suicidal thoughts
10. Hopelessness (ICD-11 adds this as 10th symptom) 2

Step 3: Differentiate from Normal Grief

Key differentiating features that indicate depression rather than normal grief 2:

• Guilt about things OTHER than actions related to the deceased
• Thoughts of death beyond joining the deceased
• Morbid preoccupation with worthlessness
• Marked psychomotor retardation
• Prolonged and marked functional impairment
• Hallucinations other than hearing/seeing the deceased

Step 4: Rule Out Medical Causes

Before finalizing the depression diagnosis, exclude 5:

• Thyroid disorders (check TSH, free T4)
• Anemia (check CBC)
• Vitamin deficiencies (B12, folate)
• Medication side effects (corticosteroids, beta-blockers, interferon)
• Substance use or withdrawal

Step 5: Assign Appropriate ICD-10 Code

If criteria for major depressive episode are met 1, 3:

• F32.0: Mild depressive episode (5-6 symptoms, minimal functional impairment)
• F32.1: Moderate depressive episode (7-8 symptoms, moderate impairment)
• F32.2: Severe depressive episode without psychotic features (≥8 symptoms, severe impairment)
• F32.3: Severe depressive episode with psychotic features
• F33.x: Use F33 series if patient has history of prior depressive episodes 7

Common Pitfalls to Avoid

Never skip the suicidal ideation assessment (PHQ-9 item 9), even in bereaved patients. 4, 6 Any endorsement of self-harm requires immediate psychiatric evaluation regardless of whether you ultimately code this as depression or normal grief.

Do not automatically diagnose depression just because someone is grieving. 2 Research shows that bereavement-related depression has lower recurrence risk than non-bereavement depression, supporting the need for a higher diagnostic threshold.

Be aware that "depressed mood" may be absent in up to 20% of patients with depression. 8 Pay special attention to anhedonia as a screening symptom, particularly in medically ill or bereaved patients who may not describe their experience as "depression."

The PHQ-9 loses accuracy in patients with cognitive impairment. 6 Use alternative assessment methods (such as informant-based tools) in elderly bereaved patients with suspected dementia.

Clinical Severity Grading

The ICD-10 severity grading has been validated and predicts both relapse risk and suicide risk 7:

• Mild (F32.0): Lowest risk of relapse and suicide
• Moderate (F32.1): Intermediate risk
• Severe (F32.2/F32.3): Highest risk of relapse and suicide

This severity grading should guide treatment intensity, not just diagnostic coding 7.