F01-F09 — Mental disorders due to known physiological conditions
ICD-10-CM codes F01-F09 cover mental disorders due to known physiological conditions, within mental, behavioral and neurodevelopmental disorders. The block holds 123 codes across 8 categories, of which 91 are billable and 32 are header codes that cannot be submitted on a claim.
Notes
Additional guidance from the ICD-10-CM tabular list.
- This block comprises a range of mental disorders grouped together on the basis of their having in common a demonstrable etiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction. The dysfunction may be primary, as in diseases, injuries, and insults that affect the brain directly and selectively; or secondary, as in systemic diseases and disorders that attack the brain only as one of the multiple organs or systems of the body that are involved.
Risk adjustment in F01-F09
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 127 Dementia, Mild or Unspecified
- HCC 125 Dementia, Severe
- HCC 126 Dementia, Moderate
What else to watch in F01-F09
- 93 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.
Categories in F01-F09
- F01Vascular dementia
- F02Dementia in other diseases classified elsewhere
- F03Unspecified dementia
- F04Amnestic disorder due to known physiological condition
- F05Delirium due to known physiological condition
- F06Other mental disorders due to known physiological condition
- F07Personality and behavioral disorders due to known physiological condition
- F09Unspecified mental disorder due to known physiological condition