ICD-10 F03.918
Billable / Specific HCC v28: 51 CCUnspecified dementia, unspecified severity, with other behavioral disturbance
About ICD-10-CM F03.918
ICD-10-CM code F03.918 represents Unspecified dementia, unspecified severity, with other behavioral disturbance. This is a billable/specific code in the Mental, Behavioral, and Neurodevelopmental chapter (block F03). The 2026 edition of ICD-10-CM F03.918 became effective on October 1, 2025.
Coding Tips for F03.918
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
F03.918 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.
F03.918 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 F03.918. Per CMS ICD-10-CM Tabular 2026.
- Unspecified dementia, unspecified severity, with behavioral disturbances such as sleep disturbance, social disinhibition, or sexual disinhibition
Use Additional Code
When coding F03.918, also report these additional codes when applicable.
- code, if applicable, to identify wandering in unspecified dementia (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 Unspecified dementia, unspecified severity, 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 F03.918
Local Coverage Determinations (LCDs) from CMS MACs that list F03.918 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 F03.918.
1 Cigna
5 Medicare
CPT Codes Commonly Billed with F03.918
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 F03.918
Other codes in section F01-F09 (Mental disorders due to known physiological conditions).
ICD-10 F03.918, Billing FAQ
Is ICD-10 code F03.918 billable? +
Yes, F03.918 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 F03.918? +
ICD-10 F03.918 includes: Unspecified dementia, unspecified severity, with behavioral disturbances such as sleep disturbance, social disinhibition, or sexual disinhibition.
Does F03.918 affect Medicare Advantage HCC risk adjustment? +
Yes. F03.918 maps to CMS-HCC v28 category 51. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is F03.918 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 F03.918? +
Procedures frequently paired with F03.918 include: G0252, 78608, A9597, A9601, G0235.
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 June 1, 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