F03.B11 — Unspecified dementia, moderate, with agitation
F03.B11 is a billable, specific ICD-10-CM code for unspecified dementia, moderate, with agitation. It is valid for submission on a claim.
Inclusion terms
Alternative wordings a physician may use in the chart for this same code.
- Unspecified dementia, moderate, with aberrant motor behavior such as restlessness, rocking, pacing, or exit-seeking
- Unspecified dementia, moderate, with verbal or physical behaviors such as profanity, shouting, threatening, anger, aggression, combativeness, or violence
Risk adjustment
F03.B11 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 126 Dementia, Moderate0.341 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score.
Medicare coverage
F03.B11 is named in 14 Medicare coverage policies — 13 listing it as supporting medical necessity, and 1 listing it as NOT covered. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.
- 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
- A56416Billing and Coding: Assays for Vitamins and Metabolic Function
How F03.B11 is indexed
Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to F03.B11.
- Dementia›moderate›with›aberrant motor behavior(exit-seeking) (pacing) (restlessness) (rocking)
- Dementia›moderate›with›agitation
- Dementia›moderate›with›verbal or physical behaviors(anger) (aggression) (combativeness) (profanity) (shouting) (threatening) (violence)
Related codes at this level
Codes that share F03.B1. If F03.B11 is not quite right, the correct code is usually one of these.
Questions about F03.B11
- Is F03.B11 a billable ICD-10-CM code?
- Yes. F03.B11 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
- Where does F03.B11 sit in the tabular list?
- Mental, Behavioral and Neurodevelopmental disorders (F01-F99), in the block Mental disorders due to known physiological conditions (F01-F09).