Skip to main content

F20.3 ICD-10-CM Code: Undifferentiated schizophrenia

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 inclusion term · 6 Excludes1 · 7 Excludes2 · 2 use-additional codes
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 57 · RxHCC V08 category 130

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 151 — Schizophrenia (supersedes HCC 152, HCC 153, HCC 154, HCC 155)

Other models: CMS-HCC V22 HCC 57 · RxHCC V08 HCC 130

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for F20.3 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on F20.3 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Atypical schizophrenia

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code, if applicable, to identify:
  • other specified cognitive deficit (R41.84-)

Source: inherited from F20

Coder workflow for F20.3

MedCoder structured workflow — derived from this code’s own official record

Before you code F20.3

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with F20.3. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in F20.3’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewF23, F25.0, F30.2, F31.2, F31.5, F31.64

Consider F20.3. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
The conditions the Use Additional Code note names
Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

  • Excludes1 — check before selecting F20.3(6 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with F20.3: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareF23, F25.0, F30.2, F31.2, F31.5, F31.64

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of F20.3(7 notes)

    Coding workflow: The conditions named in this note are not included in F20.3. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareF32.89, F10.15, F10.25, F10.95, F06.2, F21

    See the official tabular notes · Guidelines I.A.12.b

  • Use Additional Code — after identifying F20.3(2 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with F20.3 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

    ReviewR41.84

    See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition F20.3 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewF23, F25.0, F30.2, F31.2, F31.5, F31.64

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with F20.3?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewR41.84

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Code Overview

Undifferentiated schizophrenia is a billable ICD-10-CM diagnosis code (F20.3).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (2)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. 2 Use Additional Code instructions — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  2. 6 Excludes1 entries — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  3. 7 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

Verify Before Coding

  • No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name F20.3 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 4 Excludes1 notes across 2 chapters: F25 — Schizoaffective disorders (via F20.-), F53 — Mental and behavioral disorders associated with the puerperium, not elsewhere classified (via F20.-), R44 — Other symptoms and signs involving general sensations and perceptions (via F20.-), R46 — Symptoms and signs involving appearance and behavior (via F20.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 8 Excludes2 notes: F06.0 — Psychotic disorder with hallucinations due to known physiological condition (via F20.-), F06.2 — Psychotic disorder with delusions due to known physiological condition (via F20.-), F42 — Obsessive-compulsive disorder (via F20.-), F60.1 — Schizoid personality disorder (via F20.-), F63.1 — Pyromania (via F20.-), F90 — Attention-deficit hyperactivity disorders (via F20.-), F91 — Conduct disorders (via F20.-), F94.0 — Selective mutism (via F20.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code First instruction: R41.84 — Other specified cognitive deficit (via F20.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 1 MS-DRG: DRG 885 (MDC 19).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):MBD001 — Schizophrenia spectrum and other psychotic disorders (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Schizophrenia) for risk-adjusted payment.

F20.0 — Paranoid schizophrenia, F20.1 — Disorganized schizophrenia, F20.2 — Catatonic schizophrenia, F20.5 — Residual schizophrenia, F20.81 — Schizophreniform disorder, F20.89 — Other schizophrenia, F20.9 — Schizophrenia, unspecified, F25.0 — Schizoaffective disorder, bipolar type, F25.1 — Schizoaffective disorder, depressive type, F25.8 — Other schizoaffective disorders, F25.9 — Schizoaffective disorder, unspecified

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Psychosis, Except Schizophrenia, Personality Disorders; Anorexia/Bulimia Nervosa, Bipolar Disorders without Psychosis, Major Depression, Moderate or Severe, without Psychosis

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Schizophrenia spectrum and other psychotic disorders).

F19.159 — Other psychoactive substance abuse with psychoactive substance-induced psychotic disorder, unspecified, F19.250 — Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with delusions, F19.251 — Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder with hallucinations, F19.259 — Other psychoactive substance dependence with psychoactive substance-induced psychotic disorder, unspecified, F19.950 — Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with delusions, F19.951 — Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder with hallucinations, F19.959 — Other psychoactive substance use, unspecified with psychoactive substance-induced psychotic disorder, unspecified, F20.0 — Paranoid schizophrenia, F20.1 — Disorganized schizophrenia, F20.2 — Catatonic schizophrenia, F20.5 — Residual schizophrenia, F20.81 — Schizophreniform disorder, F20.89 — Other schizophrenia, F20.9 — Schizophrenia, unspecified, F21 — Schizotypal disorder, F22 — Delusional disorders, F23 — Brief psychotic disorder, F24 — Shared psychotic disorder, F25.0 — Schizoaffective disorder, bipolar type, F25.1 — Schizoaffective disorder, depressive type, +83 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Schizophrenia, schizophrenic”; these codes share that main term but sit in a different category of the Tabular List.

F21 — Schizotypal disorder (latent), F23 — Brief psychotic disorder (acute), F25.0 — Schizoaffective disorder, bipolar type (cyclic), F28 — Other psychotic disorder not due to a substance or known physiological condition (spectrum and other psychotic disorder, specified NEC), F29 — Unspecified psychosis not due to a substance or known physiological condition (spectrum and other psychotic disorder), F32.89 — Other specified depressive episodes (post-psychotic depression), F84.5 — Asperger's syndrome (syndrome of childhood)

Contextual Map

Every relationship of F20.3 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run F20.3 with these 15 related codes in Claim Check

Hierarchy

Excludes1

  • F23 — Brief psychotic disorder[Excludes1]: “acute schizophrenia-like psychotic disorder (F23)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Excludes2

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Referenced by Code First instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 151 — Schizophrenia [CMS-HCC]: “Schizophrenia — supersedes HCC 152 (Psychosis, Except Schizophrenia), HCC 153 (Personality Disorders; Anorexia/Bulimia Nervosa), HCC 154 (Bipolar Disorders without Psychosis), HCC 155 (Major Depression, Moderate or Severe, without Psychosis)”— CMS-HCC V28 · 2026

MS-DRG Grouper

  • DRG 885 — PSYCHOSES[MS-DRG]: “PSYCHOSES (MDC 19)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

  • MDC 19 — Mental Diseases and Disorders[MDC crossing]: “Mental Diseases and Disorders — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Schizophrenia, schizophrenic, atypical (form)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
  • Schizophrenia, schizophrenic, undifferentiated (type)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (9)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "F20.3 — Undifferentiated schizophrenia." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/f20.3-undifferentiated-schizophrenia

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Undifferentiated schizophrenia

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to F20.3 in its code family, with their registry titles.

View all codes in the F20 family