2025 ICD-10-CM code F06
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Mental disorders - Other mental disorders due to known physiological condition Mental, Behavioral and Neurodevelopmental disorders Feed
Other mental disorders resulting from a known physiological condition.
Modifiers are not used with ICD-10-CM codes.
Medical necessity for coding F06 is established when there's a documented causal link between a known physiological condition affecting the brain and the resulting mental disorder.This requires comprehensive documentation to support the diagnosis and the impact the mental disorder has on the patient's functioning. The treatment plan should be medically appropriate for the diagnosed symptoms.
The clinical responsibility involves the assessment, diagnosis, and management of the mental disorder secondary to the known physiological condition. This includes obtaining a complete history, conducting a physical and neuropsychological examination, ordering and interpreting relevant laboratory tests, and developing and monitoring an appropriate treatment plan which may include medication management (antidepressants, antipsychotics, etc.), psychotherapy, and supportive care.
- Mental, Behavioral and Neurodevelopmental disorders
- F01-F09 (Mental disorders due to known physiological conditions)
In simple words: This code covers mental health problems caused by a physical health problem that affects the brain.The doctor must note the physical problem, which is coded separately.Symptoms can vary widely but may include confusion, memory loss, trouble speaking or understanding, false beliefs, hallucinations, movement problems, anxiety, irritability, mood changes, suspiciousness, and aggression.
This ICD-10-CM code encompasses mental disorders stemming from a previously diagnosed physiological condition affecting brain function.The underlying physiological condition must be documented and coded first.Symptoms may include disorientation, memory impairment, language difficulties, delusions, hallucinations, movement disorders, anxiety, irritability, mood swings, paranoia, and aggressive or violent behavior. Diagnosis relies on patient history, physical and neuropsychological examinations, and potentially laboratory tests (blood work, brain imaging—CT, MRI—and EEG).
Example 1: A patient with a history of traumatic brain injury (TBI) presents with significant cognitive impairment, including memory loss, difficulty with executive functions, and changes in personality.F06 is used to code the mental disorder resulting from the TBI (the TBI itself would be coded separately)., A patient with a diagnosis of multiple sclerosis (MS) experiences worsening depression and anxiety. F06 is used to code the depression and anxiety secondary to MS (the MS diagnosis will be coded separately). , A patient with a history of stroke experiences sudden onset of disorientation, confusion, and hallucinations. F06 is used to code the mental disorder secondary to stroke, with the type of stroke coded separately. The acute care provided is also documented and coded using relevant CPT codes.
Detailed documentation should include: patient history (including history of the underlying physiological condition), mental status examination, results of neuropsychological testing, laboratory findings (blood work, brain imaging, EEG if performed), and the provider's assessment of the relationship between the underlying physiological condition and the mental disorder. Documentation should specifically state the nature of the mental disorder and its link to the underlying condition.
** This code should only be used when the mental disorder is a direct result of a documented physiological condition.It is crucial to correctly identify and code the underlying physiological condition separately.Unspecified codes should be avoided whenever possible.
- Revenue Code: Revenue codes will vary depending on the specific services provided and the payer.
- RVU: RVUs are not directly associated with ICD-10 codes; they are linked to CPT codes which describe procedures and services. The reimbursement for services related to diagnosing and treating a condition coded with F06 will depend on the specific CPT codes used and the payer's fee schedule.
- Global Days: Not applicable to ICD-10 codes.
- Payment Status: Active
- Modifier TC rule: Not applicable to ICD-10-CM codes.
- Fee Schedule: Not applicable to ICD-10-CM codes.
- Specialties:Neurology, Psychiatry, Internal Medicine, Family Medicine, Geriatrics
- Place of Service:Inpatient Hospital, Outpatient Hospital, Office, other locations as appropriate to the setting of care.