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ICD-10 Guide
ICD-10 CodesChapter 5: Mental, Behavioral and Neurodevelopmental disordersF04

F04

Billable

Amnestic disorder due to known physiological condition

Chapter 5:Mental, Behavioral and Neurodevelopmental disorders

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

Code Description

ICD-10 F04 is a billable code used to indicate a diagnosis of amnestic disorder due to known physiological condition.

Key Diagnostic Point:

Amnestic disorder due to known physiological condition is characterized by significant memory impairment that is directly attributable to a physiological condition, such as a neurological disorder, substance abuse, or a medical illness. Patients may experience difficulties in forming new memories (anterograde amnesia) or recalling past memories (retrograde amnesia). This disorder is often associated with organic mental disorders, where the underlying cause is identifiable and can include conditions like traumatic brain injury, stroke, or chronic alcohol use. Unlike other forms of amnesia, which may be psychological in nature, F04 is specifically linked to physiological factors. The clinical presentation may vary, but it often includes confusion, disorientation, and personality changes, which can complicate the patient's overall mental state. Diagnosis typically involves a thorough medical history, neurological examination, and cognitive assessments to rule out other potential causes of memory impairment. Treatment focuses on addressing the underlying physiological condition and may include rehabilitation strategies to improve cognitive function.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Requires thorough understanding of physiological conditions causing amnesia.
  • Differentiation from other types of amnestic disorders.
  • Need for comprehensive documentation of the underlying condition.
  • Potential overlap with other mental health diagnoses.

Audit Risk Factors

  • Inadequate documentation of the physiological condition.
  • Failure to specify the type of amnesia (anterograde vs. retrograde).
  • Misclassification of the disorder as a primary psychiatric condition.
  • Lack of evidence supporting the diagnosis in the medical record.

Specialty Focus

Medical Specialties

Neurology

Documentation Requirements

Detailed neurological assessments and imaging results.

Common Clinical Scenarios

Patients presenting with memory loss following a stroke or traumatic brain injury.

Billing Considerations

Ensure that the physiological cause is clearly documented to support the diagnosis.

Psychiatry

Documentation Requirements

Comprehensive mental status examinations and history of substance use.

Common Clinical Scenarios

Patients with memory impairment due to substance-induced conditions.

Billing Considerations

Differentiate between organic and functional causes of memory impairment.

Coding Guidelines

Inclusion Criteria

Use F04 When
  • According to ICD
  • 10 coding guidelines, F04 should be used when there is clear evidence of a physiological condition causing the amnestic disorder
  • Documentation must specify the nature of the physiological condition and its direct impact on memory function

Exclusion Criteria

Do NOT use F04 When
  • Exclusion criteria include cases where memory impairment is primarily psychological or due to external factors not related to a physiological condition

Related CPT Codes

96116CPT Code

Neuropsychological testing

Clinical Scenario

Used to assess cognitive function in patients with suspected amnestic disorders.

Documentation Requirements

Detailed report of cognitive assessments and findings.

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 amnestic disorders, improving the ability to capture the nuances of memory impairment related to physiological conditions. This specificity aids in better patient management and resource allocation.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of amnestic disorders, improving the ability to capture the nuances of memory impairment related to physiological conditions. This specificity aids in better patient management and resource allocation.

Reimbursement & Billing Impact

reimbursement.

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

What is the primary cause of F04?

F04 is primarily caused by identifiable physiological conditions such as neurological disorders, substance abuse, or medical illnesses that directly impact memory function.

How can I differentiate F04 from other amnestic disorders?

F04 is differentiated by the clear link to a physiological condition, whereas other amnestic disorders may not have such a direct cause.