Excludes1 pair
F03- vs F06-
F03 and F06 are not coded together. ICD-10-CM declares them mutually exclusive with an Excludes1 note — the two conditions are not expected to occur together, so exactly one of them is normally correct for a given encounter. The Official Guidelines carve out one exception: if the two conditions are clearly unrelated to each other, both may be reported.
The official note, declared on F06
unspecified dementia (F03.-)
F03
Unspecified dementia
Not billable
- Chapter 5
- Mental, Behavioral and Neurodevelopmental disorders
- Section
- F01-F09
Use when the record says
- Major neurocognitive disorder NOS
- Presenile dementia NOS
- Presenile psychosis NOS
- Primary degenerative dementia NOS
- Senile dementia NOS
- Senile dementia depressed or paranoid type
- Senile psychosis NOS
Indexed under
- Presbyophrenia
- Dementia › old age (senile)
- Dementia › presenile
- Dementia › primary degenerative
- Dementia › senile
F06
Other mental disorders due to known physiological condition
Not billable
- Chapter 5
- Mental, Behavioral and Neurodevelopmental disorders
- Section
- F01-F09
Use when the record says
- mental disorders due to endocrine disorder
- mental disorders due to exogenous hormone
- mental disorders due to exogenous toxic substance
- mental disorders due to primary cerebral disease
- mental disorders due to somatic illness
- mental disorders due to systemic disease affecting the brain
Excludes1 is not always absolute: where two conditions covered by the note are genuinely unrelated, CMS guidance permits reporting both. Document the reasoning rather than assuming it. More on Excludes1 vs Excludes2 · FY2027