Primary Care Coding Alert

Answer: Yes, you can report R53.83 (Other fatigue) and F33.1 (Major depressive disorder, recurrent, moderate) together. The first instruction for the Mental, Behavioral, and Neurodevelopmental Disorders (F01-F99) chapter of ICD-10 states “Excludes2 symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99).” This note tells you that it’s acceptable to include signs and symptoms, such as R53.83, in addition to the F33.1 diagnosis, if that is what the provider has documented in their notes. A quick look at section I.A.12.b will remind you that a “type 2 Excludes note represents ‘Not included here.’ An excludes2 note indicates that the condition excluded is not part of the condition represented by the code, but a patient may have both conditions at the same time.”

Coding alert: When you look up R53.83 as a signs and symptoms code, you’ll see the Excludes2 note that instructs that you code to F32.- if the patient has exhaustion and fatigue caused by a depressive episode. This subtle detail about how the fatigue’s cause affects coding could potentially mean the difference between an accepted claim and a rejected one.