F03.B11

F03.B11: Unspecified dementia, moderate, with agitation

Billable / specific codeICD-10-CM

F03.B11 is a billable, specific ICD-10-CM code for unspecified dementia, moderate, with agitation. It is valid for submission on a claim.

Check F03.B11 with the rest of the claim: free scrubber

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

Excludes2 inherited from the categories above F03.B11

Not part of this code, but both may be coded when both are present.

Written on F03: Unspecified dementia

dementia with delirium or acute confusional state (F05)
mild memory disturbance due to known physiological condition (F06.8)

Other codes that can never be billed with F03.B11

Their own Excludes1 notes name this code, so the conflict is not listed above.

F06Other mental disorders due to known physiological condition
F06.7Mild neurocognitive disorder due to known physiological condition
G30Alzheimer's disease
G31.84Mild cognitive impairment of uncertain or unknown etiology
R54Age-related physical debility

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. Look up the whole chart to see which of its HCCs the hierarchy would zero.

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 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
A56416Billing and Coding: Assays for Vitamins and Metabolic Function

Alphabetic index entries that lead here

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)

Code history

Unchanged in every release from FY2024 to FY2027.

Other codes under F03.B1

F03.B18Unspecified dementia, moderate, with other behavioral disturbance