F01.C11
BillableVascular dementia, severe, with agitation
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is F01.C11 an HCC code?
Yes. F01.C11 maps to Dementia, Severe under the CMS-HCC V28 risk adjustment model (and Dementia With Complications under V24).
HCC Category Mapping
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.C11
For F01.C11to 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.C11 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
F01.C11 is the ICD-10-CM diagnosis code for vascular dementia, severe, with agitation. Severe dementia caused by reduced blood flow to the brain, with agitation or restlessness. F01.C11 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.C11 maps to Dementia, Severe (HCC 125) with a community, non-dual, aged base RAF weight of 0.341. Under the older CMS-HCC V24 model, F01.C11 maps to Dementia With Complications (HCC 51) with a community, non-dual, aged base RAF weight of 0.346. 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.
Document the specific behavioral disturbance (agitation) in the medical record. Because F01.C11 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.C11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific behavioral disturbance (agitation) in the medical record
- •Distinguish agitation from other behavioral disturbances to ensure correct code selection
Clinical Significance
Vascular dementia, severe, with agitation reflects cognitive decline due to cerebrovascular pathology, classified at the severe stage with agitation (e.g., restlessness, pacing, verbal or physical aggression). This condition indicates significant neurological impairment from vascular injury to brain tissue, often associated with stroke history, small vessel disease, or chronic cerebral hypoperfusion. Accurate staging and behavioral characterization are essential for care planning, safety assessments, and appropriate risk adjustment.
Documentation Requirements
- ✓Documentation must specify: (1) the dementia type and underlying etiology — The underlying cerebrovascular disease (such as multi-infarct dementia or subcortical vascular dementia) should be coded first, with the F01 code sequenced as an additional diagnosis.
- ✓(2) Severity must be clearly stated as severe based on standardized assessment tools such as the Clinical Dementia Rating (CDR) scale or Mini-Mental State Examination (MMSE).
- ✓(3) Document specific agitation behaviors such as pacing, verbal outbursts, combativeness, or resistance to care, including frequency and triggers.
- ✓(4) Document the impact on activities of daily living, need for supervision, and current medication management.
Commonly Confused Codes
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