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F01.A11

Billable

Vascular dementia, mild, with agitation

Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)

Is F01.A11 an HCC code?

Yes. F01.A11 maps to Dementia, Mild or Unspecified under the CMS-HCC V28 risk adjustment model.

HCC Category Mapping

V28HCC 127 — Dementia, Mild or Unspecified
0.464
RxHCCHCC 112 — Dementia and Other Specified Brain Disorders
0.000

RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

MEAT Criteria for F01.A11

For F01.A11 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.

  • MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
  • EEvaluate: test results, medication response, or physical findings reviewed by the provider
  • AAssess: explicit mention in the assessment or plan with acknowledgment of status
  • TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed F01.A11 during that encounter — not just copy-forwarded from a problem list.

What This Code Means

F01.A11 is the ICD-10-CM diagnosis code for vascular dementia, mild, with agitation. This code describes a patient with early-stage dementia caused by reduced blood flow to the brain, who experiences mild memory and thinking problems along with restlessness or agitated behavior. The condition is not yet severe but is noticeable enough to affect daily functioning. F01.A11 sits in the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99), within the section covering mental disorders due to known physiological conditions (f01-f09).

Under the CMS-HCC V28 risk adjustment model, F01.A11 maps to Dementia, Mild or Unspecified (HCC 127) with a community, non-dual, aged base RAF weight of 0.464. F01.A11 was not retained as a payment HCC under the older V24 model, so V28 introduced or recategorized it during the 2024–2026 phase-in. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.

Ensure documentation specifies both the severity level (mild) and the behavioral component (agitation) before assigning this code, as these are essential elements of the diagnosis. Because F01.A11 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for F01.A11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Ensure documentation specifies both the severity level (mild) and the behavioral component (agitation) before assigning this code, as these are essential elements of the diagnosis
  • •Verify that the dementia is specifically attributed to vascular causes (such as stroke history or cerebrovascular disease) rather than other types like Alzheimer's, as this affects code selection

Clinical Significance

Mild vascular dementia with agitation indicates early-stage cerebrovascular cognitive decline with agitated behavior. Even in mild dementia, agitation can cause significant challenges for caregivers and may be an early indicator of disease progression requiring proactive behavioral management strategies.

Documentation Requirements

  • ✓Diagnosis of vascular dementia with cerebrovascular etiology
  • ✓Severity explicitly documented as 'mild'
  • ✓Documented agitation as a behavioral disturbance
  • ✓Cognitive assessment supporting mild stage
  • ✓Behavioral management plan for agitation
  • ✓Safety assessment
  • ✓Caregiver impact and support plan

Commonly Confused Codes

F01.A0 — Vascular dementia, mild, without behavioral disturbance: use when no agitation is presentF01.511 — Vascular dementia, unspecified severity, with agitation: use when severity is not specifiedF01.B11 — Vascular dementia, moderate, with agitation: use when severity is moderateF01.A18 — Vascular dementia, mild, with other behavioral disturbance: for non-agitation behavioral issues

Code Hierarchy

└F01Vascular dementia└F01.AVascular dementia, mild└F01.A1Vascular dementia, mild, with behavioral disturbance└F01.A11Vascular dementia, mild, with agitation
└F01.A11Vascular dementia, mild, with agitation

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