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ICD-10 Guide
ICD-10 CodesChapter 5: Mental, Behavioral and Neurodevelopmental disordersF03

F03

Billable

Unspecified dementia

Chapter 5:Mental, Behavioral and Neurodevelopmental disorders

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/05/2025

Code Description

ICD-10 F03 is a billable code used to indicate a diagnosis of unspecified dementia.

Key Diagnostic Point:

Unspecified dementia (ICD-10 code F03) is a diagnosis used when a patient exhibits cognitive decline that significantly interferes with daily functioning but does not meet the criteria for a specific type of dementia, such as Alzheimer's disease or vascular dementia. This condition is characterized by a progressive deterioration in cognitive abilities, including memory, reasoning, and judgment. Patients may experience difficulties with language, problem-solving, and performing familiar tasks. Behavioral symptoms such as agitation, depression, and personality changes may also be present. The diagnosis of unspecified dementia is often made when the exact cause of cognitive impairment cannot be determined, which can occur in cases where the patient has multiple risk factors or comorbidities. Early identification and management of unspecified dementia are crucial for improving patient outcomes and providing appropriate support for caregivers, who often face significant emotional and physical challenges in managing the care of individuals with dementia.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in symptoms and progression of dementia types
  • Need for comprehensive cognitive assessments
  • Differentiation from other cognitive disorders
  • Documentation of behavioral symptoms and their impact

Audit Risk Factors

  • Inadequate documentation of cognitive assessments
  • Failure to specify behavioral symptoms
  • Lack of clarity on the impact of dementia on daily functioning
  • Misdiagnosis or failure to rule out other conditions

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed cognitive assessments, neurological evaluations, and documentation of behavioral symptoms.

Common Clinical Scenarios

Patients presenting with memory loss, confusion, and changes in behavior without a clear diagnosis.

Billing Considerations

Neurologists should ensure that all potential causes of cognitive decline are explored and documented.

Geriatrics

Documentation Requirements

Comprehensive assessments of functional status, social support systems, and caregiver involvement.

Common Clinical Scenarios

Older adults with cognitive decline and multiple comorbidities.

Billing Considerations

Geriatricians should focus on the impact of dementia on the patient's quality of life and caregiver burden.

Coding Guidelines

Inclusion Criteria

Use F03 When
  • According to ICD
  • 10 coding guidelines, F03 should be used when there is evidence of cognitive decline that does not fit into a more specific category
  • Coders must ensure that all relevant documentation supports the diagnosis and that other potential causes of cognitive impairment are ruled out

Exclusion Criteria

Do NOT use F03 When
No specific exclusions found.

Related CPT Codes

96116CPT Code

Neuropsychological testing

Clinical Scenario

Used to assess cognitive function in patients suspected of having dementia.

Documentation Requirements

Document the specific tests performed and the results.

Specialty Considerations

Neurologists and psychologists should ensure comprehensive assessments are conducted.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of dementia types, but F03 remains a necessary code for cases where the type is not specified. It emphasizes the importance of thorough documentation to support the diagnosis.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of dementia types, but F03 remains a necessary code for cases where the type is not specified. It emphasizes the importance of thorough documentation to support the diagnosis.

Reimbursement & Billing Impact

impact on daily functioning. Caregiver involvement should also be documented to support the need for ongoing management.

Resources

Clinical References

  • •
    Alzheimer's Association
  • •
    National Institute on Aging

Coding & Billing References

  • •
    Alzheimer's Association
  • •
    National Institute on Aging

Frequently Asked Questions

What should I document to support the use of F03?

Document cognitive assessments, behavioral symptoms, and the impact on daily functioning. Ensure that other potential causes of cognitive decline are ruled out.

When should I use F03 instead of a specific dementia code?

Use F03 when the type of dementia is not specified or cannot be determined after thorough evaluation.