F43.23 — Adjustment Disorder, Mixed Anxiety and Depressed Mood

Clinical Description

F43.23 is used when an identifiable stressor produces a combined presentation of both anxiety and depressed mood that does not meet criteria for a specific anxiety or depressive disorder. The mixed presentation is the predominant clinical feature.

Key Symptoms to Document

When using F43.23, your documentation should reference these symptoms:

• Combined symptoms of anxiety and depressed mood following an identifiable stressor
• Excessive worry or nervousness
• Depressed or low mood, tearfulness
• Difficulty concentrating
• Sleep disturbance
• Functional impairment in social or occupational domains

Common Interventions to Document

Evidence-based interventions typically documented with this diagnosis:

• Supportive psychotherapy addressing both mood and anxiety
• Cognitive Behavioral Therapy (CBT) with coping skills focus
• Problem-solving therapy
• Relaxation training and stress management
• Brief psychodynamic psychotherapy

CPT Code Pairings

Common CPT codes used when billing with F43.23:

• 90791 — Psychiatric diagnostic evaluation
• 90834 — Individual psychotherapy, 45 minutes
• 90832 — Individual psychotherapy, 30 minutes
• 96127 — Brief emotional/behavioral assessment
• 90847 — Family psychotherapy with patient present

Documentation Tips

• Identify and document the specific stressor(s) and their temporal relationship to symptom onset.
• Note the presence of both anxiety and depressive features, describing each set of symptoms.
• Document why criteria for MDD, GAD, or PTSD are not fully met.
• Track symptom trajectory — improvement is expected once the stressor resolves or coping improves.
• Record functional impairment to support clinical significance of the diagnosis.

Differential Diagnosis Considerations

When documenting F43.23, consider and rule out:

• Major depressive disorder with anxious distress (F32.x)
• Generalized anxiety disorder (F41.1)
• Mixed anxiety and depressive disorder (F41.8)
• Post-traumatic stress disorder (F43.10)
• Adjustment disorder with depressed mood (F43.21)

Screening Tools

Standardized measures commonly used with this diagnosis:

• PHQ-9 (to screen depressive symptoms)
• GAD-7 (to screen anxiety symptoms)
• DASS-21 (Depression Anxiety Stress Scales)
• Adjustment Disorder New Module (ADNM-20)