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F98.1 ICD-10-CM Code: Encopresis not due to a substance or known physiological condition

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FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Behavioral and emotional disorders with onset usually occurring in childhood and adolescence (F90-F98)

F98.1

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Encopresis not due to a substance or known physiological condition

Involuntary or intentional passage of feces in inappropriate places in children or adults that is not caused by medical conditions, medications, or other substances.

CMS-HCC V28

N/A

—

Not mapped

CMS-HCC V24

N/A

—

Not mapped

ACA/HHS

N/A

—

Not mapped

ESRD/PACE

N/A

—

Not mapped

RXHCC

N/A

—

Not mapped

Code Book Path

Official
F98Other behavioral and emotional disorders with onset usually occurring in childhood and adolescence
F98.1Encopresis not due to a substance or known physiological condition

Inclusion Terms

Official
  • Functional encopresis
  • Incontinence of feces of nonorganic origin
  • Psychogenic encopresis

Excludes 2

Official
  • breath-holding spells (R06.89)
  • gender identity disorder of childhood (F64.2)
  • Kleine-Levin syndrome (G47.13)
  • obsessive-compulsive disorder (F42.-)
  • sleep disorders not due to a substance or known physiological condition (F51.-)

Related Child Codes

Official
F98.0Enuresis not due to a substance or known physiological condition
F98.2Other feeding disorders of infancy and childhood
F98.3Pica of infancy and childhood
F98.4Stereotyped movement disorders
F98.5Adult onset fluency disorder

Includes

Official

ICD-10-CM does not list Includes notes for F98.1 in this effective period.

Excludes 1

Official
  • encopresis NOS (R15.-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F98.1 in this effective period.

Use Additional

Official
  • code to identify the cause of any coexisting constipation.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F98.1 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Confirm that organic causes such as constipation, Hirschsprung disease, or other GI conditions have been excluded
Document whether the behavior is intentional or involuntary, and the frequency of episodes

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 F98.1 an HCC code?

No. F98.1 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.

Code
F98.1
Description
Encopresis not due to a substance or known physiological condition
HCC (V28)
No CMS-HCC V28 mapping
RAF
—
Billable
Yes
Payment year
2026

Coder workflow notes

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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).

What This Code Means

F98.1 is the ICD-10-CM diagnosis code for encopresis not due to a substance or known physiological condition. Involuntary or intentional passage of feces in inappropriate places in children or adults that is not caused by medical conditions, medications, or other substances. F98.1 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering behavioral and emotional disorders with onset usually occurring in childhood and adolescence (f90-f98).

F98.1 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

Confirm that organic causes such as constipation, Hirschsprung disease, or other GI conditions have been excluded.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F98.1 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Confirm that organic causes such as constipation, Hirschsprung disease, or other GI conditions have been excluded
  • •Document whether the behavior is intentional or involuntary, and the frequency of episodes

Excludes 1, Do NOT code together

  • encopresis NOS (R15.-)

Use Additional Code

  • code to identify the cause of any coexisting constipation.

Child Codes

F98.0Enuresis not due to a substance or known physiological condition
F98.1Encopresis not due to a substance or known physiological condition
F98.2Other feeding disorders of infancy and childhood
F98.3Pica of infancy and childhood
F98.4Stereotyped movement disorders
F98.5Adult onset fluency disorder
F98.8Other specified behavioral and emotional disorders with onset usually occurring in childhood and adolescence
F98.9Unspecified behavioral and emotional disorders with onset usually occurring in childhood and adolescence

Code Hierarchy

└F98Other behavioral and emotional disorders with onset usually occurring in childhood and adolescence└F98.1Encopresis not due to a substance or known physiological condition
└F98.1Encopresis not due to a substance or known physiological condition

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