F05: Delirium due to known physiological condition
F05 is a billable, specific ICD-10-CM code for delirium due to known physiological condition. It is valid for submission on a claim.
Check F05 with the rest of the claim: free scrubberExcludes1: never code together
These conditions cannot occur together. Billing both on the same encounter is a denial.
- delirium NOS (R41.0)
Excludes2: not included here, but may coexist
The excluded condition is not part of this code, but a patient can have both. You may code both.
Code first
The underlying condition must be sequenced before this code.
- the underlying physiological condition, such as:
- dementia (F03.9-)
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Acute or subacute brain syndrome
- Acute or subacute confusional state (nonalcoholic)
- Acute or subacute infective psychosis
- Acute or subacute organic reaction
- Acute or subacute psycho-organic syndrome
- Delirium of mixed etiology
- Delirium superimposed on dementia
- Sundowning
Other codes that can never be billed with F05
Their own Excludes1 notes name this code, so the conflict is not listed above.
- R41.0Disorientation, unspecified
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
F05 is named in 20 Medicare coverage policies: 19 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which one applies depends on your Medicare contractor.
- A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
- A53134Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions
- A54111Billing and Coding: Speech Language Pathology (SLP) Services: Communication Disorders
- A56612Billing and Coding: CT of the Head
Alphabetic index entries that lead here
- Sundowning
- Confusion, confused›epileptic
- Delirium, delirious›postprocedural(postoperative)
- Delirium, delirious›puerperal
- Epilepsy, epileptic, epilepsia›twilight
- Psychosis, psychotic›infective(acute) (subacute)
- Puerperal, puerperium›delirium NEC
- Twilight state›epileptic
- Confusion, confused›acute›with dementia
- Delirium, delirious›due to›general medical condition
- Delirium, delirious›due to›multiple etiologies
- Delirium, delirious›with›dementia
Code history
Unchanged in every release from FY2024 to FY2027.