Quick reference
- When to use
- Use F31.5 when the client has an established or newly diagnosed bipolar disorder with the current episode matching this code's specifier. Always document history of manic episodes for Bipolar I. Never assign without confirming episode polarity.
- Duration
- Manic episodes: minimum 7 days (or any duration if hospitalized). Hypomanic episodes: minimum 4 consecutive days. Depressive episodes: minimum 2 weeks. Track mood longitudinally with mood charts.
- Session codes
- Pair with CPT 90834/90837 for therapy sessions. Medication management: 99213/99214. Add 96127 for mood screening tools (MDQ, PHQ-9). Crisis: 90839. Consider 90847 for family psychoeducation.
- Key indicators
- Mood episodes (manic, hypomanic, or depressive) • History of at least one manic episode (Bipolar I) • Elevated energy + decreased sleep need • Grandiosity • Pressured speech • Risk-taking behavior • Cycling pattern
What F31.5 represents
The most severe form of bipolar depression, featuring psychotic symptoms during the depressive episode. Requires aggressive treatment and close monitoring.
Key diagnostic criteria
- History of at least one manic episode
- Current severe depressive episode
- Delusions and/or hallucinations present
- Specify mood-congruent or mood-incongruent
Documentation essentials
Document psychotic symptoms, depressive severity, bipolar history, and safety assessment.
Differential diagnosis
Distinguish from schizoaffective disorder, schizophrenia, and unipolar psychotic depression.
Treatment planning
Antipsychotic + mood stabilizer. May require hospitalization. ECT may be considered.
Insurance & billing
Strong medical necessity. Supports intensive treatment and inpatient care if needed.
Updates & changes
Monitor for pharmacotherapy updates.
Documentation pitfalls
Always specify mood-congruence of psychotic features. Thorough safety assessment essential.
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).