TL;DR
No. A medication does not document a diagnosis, and this provider wrote down why the quetiapine was added: augmentation and sleep. Major depressive disorder, single episode, severe with psychotic features (F32.3) is not supported. As documented, the note codes to F32.2: in the Alphabetic Index, "without psychotic symptoms" sits in parentheses, so the provider does not have to write it. No query is needed.
01The question and the note
Coder: "The note says 'severe major depressive disorder' and the patient is on quetiapine 100mg. Quetiapine is an antipsychotic, so there are psychotic features. Do I code F32.3?"
A/P: Major depressive disorder, single episode, severe. Poor response to sertraline alone; quetiapine 100mg qhs added for augmentation and sleep. Continue weekly therapy.
02A drug is not a diagnosis
A code is assigned from the provider's statement that a condition exists. Psychotic features are a diagnosis the provider has to document, and a medication list is not that statement. This provider also wrote down why the quetiapine was added: to augment the antidepressant and to help sleep.
03Silence goes to the default
The Alphabetic Index settles the rest. Under Disorder, depressive, major, single episode, the entry reads "severe (without psychotic symptoms)", leading to F32.2. Words in parentheses are nonessential modifiers: they may be present or absent in the diagnostic statement without changing the code. So "major depressive disorder, single episode, severe", with psychosis not mentioned, codes to F32.2. The provider does not need to write "without psychotic features".
04When a query would be warranted
Only when the record itself gives a reason to ask, such as hallucinations or delusions noted by the provider or the therapist. A query is generated only when the clinical data supports the need for clarification, and a medication the provider has already explained does not. If you do query, cite the signs that prompted it with where they were found, and include the quetiapine as well: clinical indicators may not be selectively included or left out to steer the answer. Keep the subject line neutral, for example "CDI provider query: depression".
05What the documentation supports
- As written (severe, psychosis not mentioned): F32.2.
- Psychotic features documented by the provider: F32.3.
Sources
- ICD-10-CM Official Guidelines, Section I.A.7, Parentheses (nonessential modifiers)
- ICD-10-CM Official Guidelines, Section I.A.19, Code assignment and clinical criteria
- ICD-10-CM Alphabetic Index, Disorder, depressive, major, single episode, severe
- ICD-10-CM Tabular List, F32.2 and F32.3
- AHIMA and ACDIS, Guidelines for Achieving a Compliant Query Practice (2026 update): clinical indicators, neutral presentation, when to query, query titles
Questions
Does the provider have to write "without psychotic features" for F32.2?
No. In the Alphabetic Index the phrase is a nonessential modifier, so "severe" with psychosis not mentioned already codes to F32.2.
Can treatment-resistant depression count as evidence of psychotic features?
No. A poor response to treatment has many causes and is not a documented feature.
Educational. It explains the guidelines; it is not a coding decision for a specific chart.
Neurona 28 · https://neurona28.com/blog/antipsychotic-is-not-psychosis/ · November 1, 2026