ICD-10 F02.B18
Billable / Specific HCC v28: 51 CCDementia in other diseases classified elsewhere, moderate, with other behavioral disturbance
About ICD-10-CM F02.B18
ICD-10-CM code F02.B18 represents Dementia in other diseases classified elsewhere, moderate, with other behavioral disturbance. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F02). The 2026 edition of ICD-10-CM F02.B18 became effective on October 1, 2025.
Coding Tips for F02.B18
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F02.B18 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.B18 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.B18. Per CMS ICD-10-CM Tabular 2026.
- Dementia in other diseases classified elsewhere, moderate, with behavioral disturbances such as sleep disturbance, social disinhibition, or sexual disinhibition
- Major neurocognitive disorder in other diseases classified elsewhere, moderate, with behavioral disturbance such as sleep disturbance, social disinhibition, or sexual disinhibition
Use Additional Code
When coding F02.B18, also report these additional codes when applicable.
- code, if applicable, to identify wandering in dementia in conditions classified elsewhere (Z91.83)
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, moderate, with other behavioral disturbance. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for F02.B18
Local Coverage Determinations (LCDs) from CMS MACs that list F02.B18 as a covered diagnosis.
Showing top 10 of 510 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F02.B18.
5 Medicare
CPT Codes Commonly Billed with F02.B18
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 97168 CMS LCD: Billing and Coding: Outpatient Occupational Therapy CMS LCD
- 97166 CMS LCD: Billing and Coding: Outpatient Occupational Therapy CMS LCD
- 92626 CMS LCD: Billing and Coding: Outpatient Occupational Therapy CMS LCD
- 29086 CMS LCD: Billing and Coding: Outpatient Occupational Therapy CMS LCD
- 92627 CMS LCD: Billing and Coding: Outpatient Occupational Therapy CMS LCD
- 97165 CMS LCD: Billing and Coding: Outpatient Occupational Therapy CMS LCD
- 92610 CMS LCD: Billing and Coding: Outpatient Occupational Therapy CMS LCD
- 92526 CMS LCD: Billing and Coding: Outpatient Occupational Therapy CMS LCD
- 97167 CMS LCD: Billing and Coding: Outpatient Occupational Therapy CMS LCD
- 95857 CMS LCD: Billing and Coding: Outpatient Speech Language Pathology CMS LCD
Codes Adjacent To F02.B18
Other codes in section F01-F09 (Mental disorders due to known physiological conditions).
ICD-10 F02.B18, Billing FAQ
Is ICD-10 code F02.B18 billable? +
Yes, F02.B18 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.B18? +
ICD-10 F02.B18 includes: Dementia in other diseases classified elsewhere, moderate, with behavioral disturbances such as sleep disturbance, social disinhibition, or sexual disinhibition; Major neurocognitive disorder in other diseases classified elsewhere, moderate, with behavioral disturbance such as sleep disturbance, social disinhibition, or sexual disinhibition.
Does F02.B18 affect Medicare Advantage HCC risk adjustment? +
Yes. F02.B18 maps to CMS-HCC v28 category 51. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is F02.B18 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.B18? +
Procedures frequently paired with F02.B18 include: 97168, 97166, 92626, 29086, 92627.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team