F98.1: Encopresis not due to a substance or known physiological condition
F98.1 is a billable, specific ICD-10-CM code for encopresis not due to a substance or known physiological condition. It is valid for submission on a claim.
Check F98.1 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.
- encopresis NOS (R15.-)
Use additional code
Add a secondary code to capture the detail described below.
- code to identify the cause of any coexisting constipation.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Functional encopresis
- Incontinence of feces of nonorganic origin
- Psychogenic encopresis
Excludes2 inherited from the categories above F98.1
Not part of this code, but both may be coded when both are present.
Written on F98: Other behavioral and emotional disorders with onset usually occurring in childhood and adolescence
Other codes that can never be billed with F98.1
Their own Excludes1 notes name this code, so the conflict is not listed above.
- R15Fecal incontinence
Risk adjustment
No CMS-HCC V28 category: this code does not change a RAF score.
Medicare coverage
F98.1 is named in 10 Medicare coverage policies: 8 listing it as supporting medical necessity, and 2 listing it as NOT covered. Which one applies depends on your Medicare contractor.
- A52434Health and Behavior Assessment/Intervention – Medical Policy Articlenot covered
- A56865Billing and Coding: Psychiatric Inpatient Hospitalizationnot covered
- A56937Billing and Coding: Psychiatry and Psychology Services
- A57052Billing and Coding: Psychiatric Inpatient Hospitalization
Alphabetic index entries that lead here
- Encopresis›functional
- Encopresis›nonorganic origin
- Encopresis›psychogenic
- Incontinence›feces›nonorganic origin
- Loss›control, sphincter, rectum›nonorganic origin
Code history
Unchanged in every release from FY2024 to FY2027.
Other codes under F98
- 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
- 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