What is ICD-10 code F43.23?

F43.23 is the ICD-10-CM code for Adjustment disorder with mixed anxiety and depressed mood. It sits in subcategory F43.2 (Adjustment disorders), within category F43 (Reaction to severe stress, and adjustment disorders). It applies when both anxiety and low mood follow an identifiable stressor.

Is F43.23 a billable ICD-10-CM code?

Yes, F43.23 is a billable code in the FY2027 ICD-10-CM code set (effective October 1, 2026). The other billable adjustment disorder codes are F43.20 (unspecified), F43.21 (with depressed mood), F43.22 (with anxiety), F43.24 (with disturbance of conduct), F43.25 (with mixed disturbance of emotions and conduct), and F43.29 (with other symptoms).

What are the diagnostic criteria for F43.23?

Under DSM-5-TR, adjustment disorder requires emotional or behavioural symptoms that begin within 3 months of a stressor and do not persist more than 6 months after the stressor ends. Symptoms must be clinically significant, shown by distress out of proportion to the stressor (taking culture into account), significant impairment in functioning, or both. They must not meet criteria for another disorder or be better explained by normal bereavement, prolonged grief disorder, or a worsening of an existing condition.

What is the difference between F43.21, F43.22, and F43.23?

The fifth character names the predominant symptoms. F43.21 is adjustment disorder with depressed mood, F43.22 is with anxiety, and F43.23 is with mixed anxiety and depressed mood. Choose F43.23 when both anxiety and low mood are prominent and neither clearly dominates.

What is the difference between F43.23 and F41.8 (mixed anxiety and depressive disorder)?

F41.8 (Other specified anxiety disorders) includes mixed anxiety and depressive disorder, but category F41 carries an Excludes2 note for anxiety in transient adjustment reaction (F43.2). When mixed anxiety and low mood follow an identifiable stressor within the time frame, F43.23 is the code. Without a linked stressor, an F41 or depressive disorder code is considered instead.

What scale is used to screen for F43.23?

There is no single standard screener; a dedicated adjustment disorder tool is still being validated (Geer, 2023). In practice, the PHQ-9 tracks the depressed-mood component and the GAD-7 tracks the anxiety component, giving a baseline and a way to show change over the expected course. Scores support, but do not make, the diagnosis.

How long does adjustment disorder last?

Symptoms typically begin within days of the stressful event, and by definition within 3 months. They resolve within 6 months of the end of the stressor and its consequences. Symptoms that persist beyond that window, or that meet full criteria for another disorder, call for re-evaluation of the diagnosis.

How common is adjustment disorder?

Adjustment disorder is one of the more common diagnoses in outpatient mental health care. The Merck Manual puts it at 5% to 20% of outpatient mental health visits, with population-based estimates ranging from 1% to 17%. A 2023 primary care review gives a range of 0.2% to 40% depending on the stressful circumstances (Geer, 2023).

How is adjustment disorder treated?

Treatment focuses on self-care, with psychotherapy and medication playing a role but resting on limited evidence. Brief psychological interventions are the main approach; cognitive behavioural, interpersonal, family, psychodynamic, and supportive therapies are all used. Pharmacotherapy is mostly limited to symptom management of anxiety or insomnia, and controlled trials of medication remain few (Casey, 2009; Stein, 2018).

What should be ruled out before coding F43.23?

Rule out PTSD and acute stress disorder, which have different time frames and more specific stressor criteria; major depressive disorder, which is diagnosed on symptom count rather than the course after a stressor; and normal, culturally expected grief. Screening for suicide risk and substance use is part of the assessment.

F43.23ICD-10-CMAdjustment Disorder, With Mixed Anxiety and Depressed Mood

Official ICD-10-CM descriptor: Adjustment disorder with mixed anxiety and depressed mood · Category header, not billable: use a more specific code

Emotional symptoms of both anxiety and low mood that begin within 3 months of an identifiable stressor, are out of proportion to it or impair functioning, and do not last more than 6 months after the stressor and its consequences end.

Recommended screener

Validated screener
Patient Health Questionnaire-9 (PHQ-9)
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DSM-5-TR diagnostic criteria summary

Adjustment disorder requires:

Emotional or behavioural symptoms in response to an identifiable stressor, beginning within 3 months of the stressor.
Clinical significance: distress out of proportion to the stressor (considering cultural factors), significant impairment in functioning, or both.
Not another disorder: the symptoms do not meet criteria for another mental disorder and are not an exacerbation of an existing one.
Not normal grief: not better explained by normal bereavement or prolonged grief disorder.
Time-limited: once the stressor and its consequences end, symptoms do not persist more than 6 months.

For F43.23, both anxiety and depressed mood are prominent.

Source: Barnhill, J. W. (2026). Adjustment disorders. Merck Manual Professional Edition, summarizing DSM-5-TR (American Psychiatric Association, 2022).

Differential diagnosis

Adjustment Disorder with Depressed Mood (F43.21) or with Anxiety (F43.22), when one symptom type clearly predominates.
PTSD (F43.10) and Acute Stress Reaction (F43.0), which require a traumatic stressor and have different time frames.
Major Depressive Disorder (F32.1, F33.1), diagnosed on symptom count; if full criteria are met, code the depressive disorder.
Generalized Anxiety Disorder (F41.1) and Anxiety Disorder, Unspecified (F41.9), anxiety not tied to a recent stressor.
Prolonged Grief Disorder (F43.81) and normal bereavement, after a death.

Common comorbidities

Adjustment disorder symptoms overlap with those of other common conditions, and the distinction from major depression in particular can be difficult (Casey, 2009). Track depression and anxiety scores over time, screen for suicide risk and substance use, and re-evaluate if symptoms persist past the expected window.

Documentation patterns

Initial visit: the identifiable stressor and its date, symptom onset relative to it, PHQ-9 and GAD-7 scores, functional impact, and what has been ruled out.
Follow-up visits: repeat PHQ-9 and GAD-7, note whether the stressor is ongoing or has ended, and record the date it ended so the 6-month limit can be tracked.

Sources

Centers for Disease Control and Prevention, National Center for Health Statistics. (2026). ICD-10-CM Tabular List of Diseases and Injuries, FY2027 (effective October 1, 2026). https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/
Barnhill, J. W. (2026). Adjustment disorders. Merck Manual Professional Edition.
Casey, P. (2009). Adjustment disorder: Epidemiology, diagnosis and treatment. CNS Drugs, 23(11), 927–938.
Geer, K. (2023). Adjustment disorder: Diagnosis and treatment in primary care. Primary Care, 50(1), 83–88.
Stein, D. J. (2018). Pharmacotherapy of adjustment disorder: A review. World Journal of Biological Psychiatry, 19(sup1), S46–S52.
Osborn, J., Raetz, J., & Kost, A. (2014). Seasonal affective disorder, grief reaction, and adjustment disorder. Medical Clinics of North America, 98(5), 1065–1077.

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Frequently asked questions

What is ICD-10 code F43.23?
F43.23 is the ICD-10-CM code for Adjustment disorder with mixed anxiety and depressed mood. It sits in subcategory F43.2 (Adjustment disorders), within category F43 (Reaction to severe stress, and adjustment disorders). It applies when both anxiety and low mood follow an identifiable stressor.
Is F43.23 a billable ICD-10-CM code?
Yes, F43.23 is a billable code in the FY2027 ICD-10-CM code set (effective October 1, 2026). The other billable adjustment disorder codes are F43.20 (unspecified), F43.21 (with depressed mood), F43.22 (with anxiety), F43.24 (with disturbance of conduct), F43.25 (with mixed disturbance of emotions and conduct), and F43.29 (with other symptoms).
What are the diagnostic criteria for F43.23?
Under DSM-5-TR, adjustment disorder requires emotional or behavioural symptoms that begin within 3 months of a stressor and do not persist more than 6 months after the stressor ends. Symptoms must be clinically significant, shown by distress out of proportion to the stressor (taking culture into account), significant impairment in functioning, or both. They must not meet criteria for another disorder or be better explained by normal bereavement, prolonged grief disorder, or a worsening of an existing condition.
What is the difference between F43.21, F43.22, and F43.23?
The fifth character names the predominant symptoms. F43.21 is adjustment disorder with depressed mood, F43.22 is with anxiety, and F43.23 is with mixed anxiety and depressed mood. Choose F43.23 when both anxiety and low mood are prominent and neither clearly dominates.
What is the difference between F43.23 and F41.8 (mixed anxiety and depressive disorder)?
F41.8 (Other specified anxiety disorders) includes mixed anxiety and depressive disorder, but category F41 carries an Excludes2 note for anxiety in transient adjustment reaction (F43.2). When mixed anxiety and low mood follow an identifiable stressor within the time frame, F43.23 is the code. Without a linked stressor, an F41 or depressive disorder code is considered instead.
What scale is used to screen for F43.23?
There is no single standard screener; a dedicated adjustment disorder tool is still being validated (Geer, 2023). In practice, the PHQ-9 tracks the depressed-mood component and the GAD-7 tracks the anxiety component, giving a baseline and a way to show change over the expected course. Scores support, but do not make, the diagnosis.
How long does adjustment disorder last?
Symptoms typically begin within days of the stressful event, and by definition within 3 months. They resolve within 6 months of the end of the stressor and its consequences. Symptoms that persist beyond that window, or that meet full criteria for another disorder, call for re-evaluation of the diagnosis.
How common is adjustment disorder?
Adjustment disorder is one of the more common diagnoses in outpatient mental health care. The Merck Manual puts it at 5% to 20% of outpatient mental health visits, with population-based estimates ranging from 1% to 17%. A 2023 primary care review gives a range of 0.2% to 40% depending on the stressful circumstances (Geer, 2023).
How is adjustment disorder treated?
Treatment focuses on self-care, with psychotherapy and medication playing a role but resting on limited evidence. Brief psychological interventions are the main approach; cognitive behavioural, interpersonal, family, psychodynamic, and supportive therapies are all used. Pharmacotherapy is mostly limited to symptom management of anxiety or insomnia, and controlled trials of medication remain few (Casey, 2009; Stein, 2018).
What should be ruled out before coding F43.23?
Rule out PTSD and acute stress disorder, which have different time frames and more specific stressor criteria; major depressive disorder, which is diagnosed on symptom count rather than the course after a stressor; and normal, culturally expected grief. Screening for suicide risk and substance use is part of the assessment.