F33.1 — Major Depressive Disorder, Recurrent, Moderate

Clinical Description

F33.1 applies when a patient has experienced two or more episodes of major depressive disorder and the current episode is moderate in severity. Clinicians must document the history of prior episodes and distinguish recurrent MDD from chronic or persistent forms.

Key Symptoms to Document

When using F33.1, your documentation should reference these symptoms:

• Depressed mood persisting most of the day for at least 2 weeks
• Anhedonia with loss of interest in previously enjoyed activities
• Sleep disturbance (insomnia or hypersomnia)
• Appetite or weight changes
• Fatigue and decreased energy
• Feelings of hopelessness or excessive guilt

Common Interventions to Document

Evidence-based interventions typically documented with this diagnosis:

• Continuation/maintenance antidepressant pharmacotherapy
• Cognitive Behavioral Therapy (CBT)
• Mindfulness-Based Cognitive Therapy (MBCT) for relapse prevention
• Interpersonal Therapy (IPT)
• Collaborative care model with medication management

CPT Code Pairings

Common CPT codes used when billing with F33.1:

• 90791 — Psychiatric diagnostic evaluation
• 90834 — Individual psychotherapy, 45 minutes
• 90837 — Individual psychotherapy, 60 minutes
• 99214 — Office visit, moderate complexity (medication management)
• 96127 — Brief emotional/behavioral assessment

Documentation Tips

• Document the number and approximate timing of prior depressive episodes to justify the 'recurrent' specifier.
• Note whether the patient achieved full remission between episodes or had residual symptoms.
• Record the current PHQ-9 score (moderate range: 10-14) and compare to baseline or prior episode scores.
• Include a relapse prevention plan and document maintenance treatment rationale.
• Assess and document medication history, including prior trials, responses, and side effects.

Differential Diagnosis Considerations

When documenting F33.1, consider and rule out:

• Persistent depressive disorder / Dysthymia (F34.1)
• Bipolar disorder, depressive episode (F31.x)
• Major depressive disorder, single episode (F32.1)
• Cyclothymic disorder (F34.0)
• Schizoaffective disorder, depressive type (F25.1)

Screening Tools

Standardized measures commonly used with this diagnosis:

• PHQ-9 (Patient Health Questionnaire-9)
• BDI-II (Beck Depression Inventory-II)
• C-SSRS (Columbia Suicide Severity Rating Scale)
• QIDS-SR (Quick Inventory of Depressive Symptomatology)