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ICD-10 Guide
ICD-10 CodesF03.91

F03.91

Billable

Unspecified dementia, unspecified severity, with behavioral disturbance

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

Code Description

ICD-10 F03.91 is a billable code used to indicate a diagnosis of unspecified dementia, unspecified severity, with behavioral disturbance.

Key Diagnostic Point:

F03.91 refers to unspecified dementia characterized by cognitive decline that significantly impacts daily functioning, accompanied by behavioral disturbances. This code is utilized when the specific type of dementia (such as Alzheimer's disease, vascular dementia, or frontotemporal dementia) is not clearly defined, and the severity of cognitive impairment is not specified. Behavioral disturbances may include agitation, aggression, mood swings, and other disruptive behaviors that can complicate care and management. The diagnosis of unspecified dementia is often made when comprehensive cognitive assessments do not yield a definitive type of dementia, yet the patient exhibits clear signs of cognitive decline and behavioral issues. It is crucial for healthcare providers to conduct thorough evaluations, including neuropsychological testing and assessments of daily living activities, to understand the patient's condition better and to provide appropriate interventions. Caregiver support is essential, as managing behavioral disturbances can be challenging and may require additional resources and strategies to ensure the safety and well-being of both the patient and the caregiver.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Lack of specificity in the type of dementia
  • Variability in behavioral symptoms
  • Need for comprehensive cognitive assessments
  • Potential overlap with other dementia types

Audit Risk Factors

  • Inadequate documentation of cognitive assessments
  • Failure to specify behavioral disturbances
  • Misclassification of dementia type
  • Lack of supporting evidence for severity

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed cognitive assessments, behavioral observations, and treatment plans.

Common Clinical Scenarios

Patients presenting with memory loss, confusion, and behavioral changes.

Billing Considerations

Neurologists must ensure comprehensive evaluations to differentiate between types of dementia.

Geriatrics

Documentation Requirements

Assessment of functional status, caregiver reports, and management plans.

Common Clinical Scenarios

Older adults with cognitive decline and behavioral issues requiring multidisciplinary care.

Billing Considerations

Geriatricians should focus on the impact of dementia on daily living and caregiver support.

Coding Guidelines

Inclusion Criteria

Use F03.91 When
  • According to ICD
  • 10 coding guidelines, F03
  • 91 should be used when the type of dementia is not specified, and there is evidence of cognitive decline and behavioral disturbances
  • Coders must ensure that documentation supports the diagnosis and reflects the patient's condition accurately

Exclusion Criteria

Do NOT use F03.91 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

96116CPT Code

Neuropsychological testing

Clinical Scenario

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

Documentation Requirements

Detailed reports of cognitive assessments and behavioral observations.

Specialty Considerations

Neurologists and psychologists should collaborate on documentation.

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 F03.91 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 F03.91 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

The transition to ICD-10 has allowed for more specific coding of dementia types, but F03.91 remains a necessary code for cases where the type is not specified. It emphasizes the importance of thorough documentation to support the diagnosis.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

When should I use F03.91?

Use F03.91 when a patient exhibits cognitive decline and behavioral disturbances, but the specific type of dementia is not identified.

What documentation is needed for F03.91?

Documentation should include cognitive assessments, behavioral observations, and any relevant history that supports the diagnosis of unspecified dementia.