Shed Light on Coding SAD

Accurate ICD-10-CM reporting starts with understanding seasonal affective disorder.

December is Seasonal Depression Awareness Month, and for good reason: In the United States, this month gets the least amount of daylight hours and, in some parts of the country, the least amount of sunshine. The weather isn’t all that great either, so we tend to spend less time outside soaking up what sun there is. As such, people who are genetically predisposed to depression are more likely to experience seasonal affective disorder (SAD) in the winter.

SAD is a type of depression that should be taken seriously. Correct coding is paramount to not only proper reimbursement and quality reporting but, more importantly, a patient’s health outcome.

What Is SAD?

Most people experience short periods of melancholy from time to time, but SAD is more than the occasional winter doldrums.

Telltale symptoms of winter-pattern SAD include:

  • Lethargy
  • Hypersomnia (sleep too much)
  • Social withdrawal
  • Change in eating habits (anorexia, bulimia, carb loading)

There is also summer-pattern SAD, but it is less common. Symptoms are generally the inverse of winter-pattern SAD symptoms.

Understanding that SAD is a subtype of major depressive disorder is important. A physician may diagnose a patient with SAD if they “meet full criteria for major depression coinciding with specific seasons for at least 2 years,” according to the National Institute of Mental Health (NIMH). Symptoms of major depression include:

  • Depression
  • Hopelessness
  • Lethargy
  • Disinterest in activities normally enjoyed
  • Insomnia
  • Irritability
  • Inability to concentrate
  • Suicidal thoughts

Of course, it’s more complicated than that. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria are even more specific: The patient’s depression can’t be due to seasonal stressors; the patient must experience full remissions in other seasons; and the patient must have had two depressive episodes in the past two years that included five or more symptoms for major depressive disorder.

Risk Factors for SAD

There are certain demographics that increase a person’s risk for SAD. They are:

Gender: Women are four times more often diagnosed with SAD than men. That’s not to say women corner the market on depression — one possibility is that they are more likely to seek help.

Geography: People who live far from the equator are more susceptible because of the fewer daylight hours, especially approaching winter solstice.

Genetics: People with a family history of depression are predisposed to SAD.

Depression: People with depression are predisposed to SAD.

Age: Younger adults are more prone to SAD than older adults. Children and teens are also susceptible.

What Causes SAD?

Although SAD is associated with a decrease in sunlight, it’s the causal effects of not enough sun that are believed to be at fault. Our bodies need sunlight to make and regulate certain hormones (serotonin and melatonin) and vitamin D. When sunlight hours decrease, people predisposed to depression may experience an imbalance of these elements more so than others. Or, perhaps, they are more sensitive to these biological imbalances.

How to Treat SAD

A patient diagnosed with SAD may benefit from certain treatments and therapies, including:

  • Light therapy
  • Vitamin D supplements
  • Psychotherapy (cognitive behavior)
  • Medication (anti-depressants)

A doctor may prescribe one or more of these modalities concurrently or one at a time.

Regular exercise, healthy eating, getting enough sleep, and staying active and connected can help, according to the American Psychiatric Association. That last suggestion may be difficult during the public health emergency for COVID-19; SAD diagnoses may be at an all-time high this winter because of social distancing requirements.

Coding SAD

SAD is a disorder, so begin your code search in ICD-10-CM by looking up “disorder” in the Index. Then, look for “depressive.” Next, find “recurrent” to locate F33.9 Major depressive disorder, recurrent, unspecified. In the Tabular List, an Includes note confirms that you may report “recurrent episodes of seasonal depressive disorder” with this code.

If the provider documents the severity of depression, you may be able to code with more specificity using one of these codes:

F33.0     Major depressive disorder, recurrent, mild

F33.1     Major depressive disorder, recurrent, moderate

F33.2     Major depressive disorder, recurrent severe without psychotic features

F33.3     Major depressive disorder, recurrent, severe with psychotic symptoms

When a patient’s SAD is in full remission, report instead:

F33.42   Major depressive disorder, recurrent, in full remission

The provider should update the patient’s status in the medical record, as appropriate, to ensure proper coding.

Here Comes the Sun

An estimated 10 million Americans are diagnosed with SAD, according to Psychology Today. Ensure proper diagnosis coding so they can get the help they need.


NIH/NIMH. Seasonal Affective Disorder. March 2016.

MedlinePlus, National Library of Medicine.

Psychology Today. “Seasonal Affective Disorder.” Feb. 7, 2019.

American Psychiatric Association.

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