F04 ICD-10-CM Code: Amnestic disorder due to known physiological condition
F04 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC Buddy coding tools
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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental disorders due to known physiological conditions (F01-F09)
F04
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceAmnestic disorder due to known physiological condition
Memory loss or difficulty forming new memories caused by a known medical condition, injury, or physical illness rather than a primary psychiatric disorder.
Buddy Insight
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.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
N/A—
Not mapped
ESRD/PACE
MappedHCC 52
Code-level coefficient reference
RXHCC
MappedHCC 112
Code-level coefficient reference
Code Book Path
Inclusion Terms
Official- Korsakov's psychosis or syndrome, nonalcoholic
Excludes 2
Official- alcohol-induced or unspecified Korsakov's syndrome (F10.26, F10.96)
- Korsakov's syndrome induced by other psychoactive substances (F13.26, F13.96, F19.16, F19.26, F19.96)
- symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99
Related Codes
No related codes are included in this display for F04. Check the Code Book for the complete code path.
Includes
Official- disorders of psychological developmentInherited from F01-F99
Excludes 1
Official- amnesia NOS (R41.3)
- anterograde amnesia (R41.1)
- dissociative amnesia (F44.0)
- retrograde amnesia (R41.2)
Code First
Official- the underlying physiological condition
Use Additional
OfficialNo Use Additional Code instructions are included in this display for F04. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for F04. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is F04 an HCC code?
F04 has no mapping under the current CMS-HCC V28 community payment model. F04 has a separate mapping under the CMS-HCC ESRD model (HCC 52 (Dementia Without Complication)) and the Part D RxHCC model (HCC 112 (Dementia, Except Alzheimer's Disease)); the applicable result needs member context.
- Code
- F04
- Description
- Amnestic disorder due to known physiological condition
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work F04 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for F04
For F04, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Coder workflow notes
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What This Code Means
F04 is the ICD-10-CM diagnosis code for amnestic disorder due to known physiological condition. Memory loss or difficulty forming new memories caused by a known medical condition, injury, or physical illness rather than a primary psychiatric disorder. F04 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mental disorders due to known physiological conditions (f01-f09).
F04 has no mapping under the current CMS-HCC V28 community payment model. F04 has a separate mapping under the CMS-HCC ESRD model (HCC 52 (Dementia Without Complication)) and the Part D RxHCC model (HCC 112 (Dementia, Except Alzheimer's Disease)); the applicable result needs member context. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.
Always identify and document the underlying physiological condition causing the amnestic disorder.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for F04 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
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 loss
- •R41.1: Anterograde amnesia; use R41.1 for symptom-level coding when no underlying physiological cause is established
- •R41.2: Retrograde amnesia; symptom code for memory loss without established physiological cause
- •F10.26: Alcohol dependence with alcohol-induced persisting amnestic disorder; use when alcohol is the identified cause
- •F44.0: Dissociative amnesia; this is a psychological/dissociative condition, not due to a physiological cause