ICDcodes.org
FY2027

F03 vs F06

F03 and F06 can never be reported together. ICD-10-CM declares them mutually exclusive with an Excludes1 note, meaning the two conditions cannot occur in the same patient — so exactly one of them is correct for any given encounter.

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 (degenerative (primary)) (persisting) (unspecified severity) (without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety)
  • Dementia › presenile (degenerative (primary)) (persisting) (unspecified severity) (without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety)
  • Dementia › primary degenerative (degenerative (primary)) (persisting) (unspecified severity) (without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety)
  • Dementia › senile (degenerative (primary)) (persisting) (unspecified severity) (without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety)
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