ICD-10 F03.911
Billable / Specific HCC v28: 51 CCUnspecified dementia, unspecified severity, with agitation
About ICD-10-CM F03.911
ICD-10-CM code F03.911 represents Unspecified dementia, unspecified severity, with agitation. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F03). The 2026 edition of ICD-10-CM F03.911 became effective on October 1, 2025.
Coding Tips for F03.911
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F03.911 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.
F03.911 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 F03.911. Per CMS ICD-10-CM Tabular 2026.
- Unspecified dementia, unspecified severity, with aberrant motor behavior such as restlessness, rocking, pacing, or exit-seeking
- Unspecified dementia, 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 Unspecified dementia, 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 F03.911
Local Coverage Determinations (LCDs) from CMS MACs that list F03.911 as a covered diagnosis.
Showing top 10 of 377 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing F03.911.
2 Cigna
5 Medicare
CPT Codes Commonly Billed with F03.911
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- G0252 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- 78608 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- A9597 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- A9601 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- G0235 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- 78609 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- A9552 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- G0219 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- A9598 CMS LCD: Billing and Coding: NCD Coding Article for Positron Emission Tomography (PET) Scans Used for Non-Oncologic Conditions CMS LCD
- G0156 CMS LCD: Billing and Coding: Home Health - Psychiatric Care CMS LCD
Codes Adjacent To F03.911
Other codes in section F01-F09 (Mental disorders due to known physiological conditions).
ICD-10 F03.911, Billing FAQ
Is ICD-10 code F03.911 billable? +
Yes, F03.911 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 F03.911? +
ICD-10 F03.911 includes: Unspecified dementia, unspecified severity, with aberrant motor behavior such as restlessness, rocking, pacing, or exit-seeking; Unspecified dementia, unspecified severity, with verbal or physical behaviors such as profanity, shouting, threatening, anger, aggression, combativeness, or violence.
Does F03.911 affect Medicare Advantage HCC risk adjustment? +
Yes. F03.911 maps to CMS-HCC v28 category 51. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is F03.911 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 F03.911? +
Procedures frequently paired with F03.911 include: G0252, 78608, A9597, A9601, G0235.
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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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