F04
BillableAmnestic disorder due to known physiological condition
HCC Category Mapping
RxHCCHCC 112 — Dementia and Other Specified Brain Disorders
0.000What This Code Means
Memory loss or difficulty forming new memories caused by a known medical condition, injury, or physical illness rather than a primary psychiatric disorder.
Coding Tips
- •Always identify and document the underlying physiological condition causing the amnestic disorder
- •This code requires a known medical cause; if no cause is identified, use a different code
Clinical Significance
Amnestic disorder due to known physiological condition represents a specific memory impairment caused by an identified medical condition such as traumatic brain injury, cerebrovascular disease, or substance exposure. Unlike dementia, the cognitive deficit is primarily limited to memory function while other cognitive domains remain relatively intact. Accurate coding is important for differentiating from dementia and ensuring appropriate neuropsychological follow-up.
Documentation Requirements
- ✓Clear documentation of a significant memory impairment (anterograde and/or retrograde amnesia)
- ✓Identification of the underlying physiological condition causing the amnestic disorder
- ✓Evidence that the memory deficit is disproportionate to other cognitive functions (distinguishing from dementia)
- ✓Neuropsychological testing or cognitive assessment results supporting the diagnosis
- ✓Code the underlying physiological condition first, then assign F04 as an additional code
Excludes 1 — Do NOT code together
Excludes 2 — Not included here, may code separately
Code First
- the underlying physiological condition
Commonly Confused Codes
F03.x — Unspecified dementia; dementia involves global cognitive decline, not isolated memory lossR41.1 — Anterograde amnesia; use R41.1 for symptom-level coding when no underlying physiological cause is establishedR41.2 — Retrograde amnesia; symptom code for memory loss without established physiological causeF10.26 — Alcohol dependence with alcohol-induced persisting amnestic disorder; use when alcohol is the identified causeF44.0 — Dissociative amnesia; this is a psychological/dissociative condition, not due to a physiological cause
Code Hierarchy
└F04Amnestic disorder due to known physiological condition
└F04Amnestic disorder due to known physiological condition