ICD-10 F02.811
Billable / Specific HCC v28: 51 CCDementia in other diseases classified elsewhere, unspecified severity, with agitation
About ICD-10-CM F02.811
ICD-10-CM code F02.811 represents Dementia in other diseases classified elsewhere, unspecified severity, with agitation. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F02). The 2026 edition of ICD-10-CM F02.811 became effective on October 1, 2025.
Coding Tips for F02.811
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F02.811 is a CMS-HCC v28 risk-adjustment code (category 51). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
F02.811 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inclusion Terms / Approximate Synonyms
Clinical terms and conditions classified under F02.811. Per CMS ICD-10-CM Tabular 2026.
- Dementia in other diseases classified elsewhere, unspecified severity, with aberrant motor behavior such as restlessness, rocking, pacing, or exit-seeking
- Dementia in other diseases classified elsewhere, unspecified severity, with verbal or physical behaviors such as profanity, shouting, threatening, anger, aggression, combativeness, or violence
- Major neurocognitive disorder in other diseases classified elsewhere, unspecified severity, with aberrant motor behavior such as restlessness, rocking, pacing, or exit-seeking
- Major neurocognitive disorder in other diseases classified elsewhere, unspecified severity, with verbal or physical behaviors such as profanity, shouting, threatening, anger, aggression, combativeness, or violence
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, CC
codes Dementia in other diseases classified elsewhere, unspecified severity, with agitation. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for F02.811
Local Coverage Determinations (LCDs) from CMS MACs that list F02.811 as a covered diagnosis.
Showing top 10 of 277 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F02.811.
3 Cigna
5 Medicare
CPT Codes Commonly Billed with F02.811
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 90865 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
- 90889 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
- G0451 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
- 90880 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
- 90839 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
- G0017 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
- 90840 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
- G0018 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
- G0560 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
- 90845 CMS LCD: Billing and Coding: Psychiatric Codes CMS LCD
Codes Adjacent To F02.811
Other codes in section F01-F09 (Mental disorders due to known physiological conditions).
ICD-10 F02.811, Billing FAQ
Is ICD-10 code F02.811 billable? +
Yes, F02.811 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
What other names or terms map to F02.811? +
ICD-10 F02.811 includes: Dementia in other diseases classified elsewhere, unspecified severity, with aberrant motor behavior such as restlessness, rocking, pacing, or exit-seeking; Dementia in other diseases classified elsewhere, unspecified severity, with verbal or physical behaviors such as profanity, shouting, threatening, anger, aggression, combativeness, or violence; Major neurocognitive disorder in other diseases classified elsewhere, unspecified severity, with aberrant motor behavior such as restlessness, rocking, pacing, or exit-seeking, and 1 more clinical synonyms.
Does F02.811 affect Medicare Advantage HCC risk adjustment? +
Yes. F02.811 maps to CMS-HCC v28 category 51. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is F02.811 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with F02.811? +
Procedures frequently paired with F02.811 include: 90865, 90889, G0451, 90880, 90839.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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