Quick reference
- When to use
- Use F43.23 when the client's presentation is directly linked to an identifiable stressor or traumatic event and meets the specific criteria for Adjustment Disorder with Mixed Anxiety and Depressed Mood. Document the qualifying event or stressor clearly.
- Duration
- PTSD: symptoms >1 month post-trauma. Acute Stress: 3 days to 1 month. Adjustment Disorders: onset within 3 months of stressor, resolves within 6 months after stressor ends. Reassess timeline regularly.
- Session codes
- Pair with CPT 90837 (60-min, preferred for trauma processing), 90834 (45-min for stabilization), or 90791 (initial evaluation). Add 96127 for PCL-5 or PHQ-9 screening. EMDR/exposure sessions often require 90837.
- Key indicators
- Intrusive memories or flashbacks • Avoidance of trauma reminders • Negative mood or cognition changes • Hyperarousal or hypervigilance • Sleep disturbance • Dissociative symptoms • Clear temporal link to stressor
What F43.23 represents
A common presentation where both anxiety and depressive symptoms appear in response to a stressor, but neither predominates sufficiently for a more specific diagnosis.
Key diagnostic criteria
- Adjustment disorder criteria met
- Both depressive and anxiety symptoms present
- Neither symptom set meets criteria for a specific mood or anxiety disorder
Documentation essentials
Document both anxiety and depressive symptoms. Identify the stressor. Note functional impact.
Differential diagnosis
Consider comorbid MDD and GAD, mixed anxiety-depressive disorder.
Treatment planning
Address both symptom domains. CBT targeting both depression and anxiety. Supportive interventions.
Insurance & billing
Accepted code. Document both symptom domains clearly.
Updates & changes
No significant changes expected.
Documentation pitfalls
Reassess if symptoms persist – may need to transition to specific mood or anxiety disorder diagnosis.
References
- American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).