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F01.C18 ICD-10-CM Code: Vascular dementia, severe, with other behavioral disturbance

F01.C18 maps to CMS-HCC V28 125. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

ICD-10-CM Code View

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Code lookupF01.C18

FY 2026 Apr update / Mental, Behavioral and Neurodevelopmental disorders (F01-F99) / Mental disorders due to known physiological conditions (F01-F09)

F01.C18

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Vascular dementia, severe, with other behavioral disturbance

Severe dementia caused by reduced blood flow to the brain, with behavioral problems other than agitation.

Buddy the Bee presenting code insight

Buddy Insight

Vascular dementia, severe, with other behavioral disturbance reflects cognitive decline due to cerebrovascular pathology, classified at the severe stage with behavioral disturbance other than agitation (e.

OverviewRisk ModelsCode BookDocumentationAuditNotesEdition comparison

CMS-HCC V28

HCC 125

Coefficient HCC 125: 0.341 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

N/A

—

Not mapped

ESRD/PACE

Context needed

HCC 51

Coefficient needs member context

RXHCC

Context needed

HCC 112

Coefficient needs member context

Code Book Path

Official
F01.CVascular dementia, severeF01.C1Vascular dementia, severe, with behavioral disturbanceF01.C18Vascular dementia, severe, with other behavioral disturbance

Inclusion Terms

Official
  • Major neurocognitive disorder due to vascular disease, severe, with behavioral disturbances such as sleep disturbance, social disinhibition, or sexual disinhibition
  • Vascular dementia, severe, with behavioral disturbances such as sleep disturbance, social disinhibition, or sexual disinhibition
  • Vascular dementia as a result of infarction of the brain due to vascular disease, including hypertensive cerebrovascular disease.Inherited from F01

Excludes 2

Official
  • symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)Inherited from F01-F99

Related Codes

Official
F01.C11Vascular dementia, severe, with agitation

Includes

Official
  • disorders of psychological developmentInherited from F01-F99, F01
  • arteriosclerotic dementiaInherited from F01-F99, F01
  • major neurocognitive disorder due to vascular diseaseInherited from F01-F99, F01
  • multi-infarct dementiaInherited from F01-F99, F01

Excludes 1

Official

No Excludes 1 notes are included in this display for F01.C18. Check the code and parent instructions in the Code Book.

Code First

Official
  • , if applicable, any causal conditionInherited from F01

Use Additional

Official
  • code, if applicable, to identify wandering in vascular dementia (Z91.83)

Code Also

Official

No Code Also instructions are included in this display for F01.C18. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance
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 the specific behavioral disturbance type, such as wandering, sleep-wake cycle disruption, disinhibition, or repetitive behaviors.
(4) Document the impact on activities of daily living, need for supervision, and current medication management.

MEAT Support

HCC Buddy guidance
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 the specific behavioral disturbance type, such as wandering, sleep-wake cycle disruption, disinhibition, or repetitive behaviors.
(4) Document the impact on activities of daily living, need for supervision, and current medication management.

Audit Caution

HCC Buddy guidance
Failing to code the underlying cerebrovascular disease first — F01 codes have a code-first requirement for the causative vascular condition (e.g., cerebral infarction, cerebral atherosclerosis). Failing to document the specific behavioral disturbance type — 'other behavioral disturbance' should be supported by documentation of the actual behavior (wandering, sleep disturbance, etc.) rather than used as a catch-all.
Incorrect staging can result in either over- or under-reporting risk, affecting both compliance and reimbursement accuracy. Overlooking the ICD-10-CM guideline requiring that dementia behavioral codes be used as combination codes — do not assign both a dementia code and a separate code for the behavioral/psychiatric manifestation when the combination code exists.

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is F01.C18 an HCC code?

Yes. F01.C18 (Vascular dementia, severe, with other behavioral disturbance) maps to HCC 125, Dementia, Severe under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.341. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: F01.C18 is billable and maps to V28 HCC 125, Dementia, Severe. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
F01.C18
Description
Vascular dementia, severe, with other behavioral disturbance
HCC (V28)
HCC 125 — Dementia, Severe
RAF reference coefficient
0.341
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 125, Dementia, Severe
0.341

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work F01.C18 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F01.C18

For F01.C18, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

  • 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

Coder workflow notes

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What This Code Means

F01.C18 is the ICD-10-CM diagnosis code for vascular dementia, severe, with other behavioral disturbance. Severe dementia caused by reduced blood flow to the brain, with behavioral problems other than agitation. F01.C18 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.C18 maps to Dementia, Severe (HCC 125) with a source-labeled community, non-dual, aged reference coefficient of 0.341. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Document the specific behavioral disturbance in detail (e.g., wandering, verbal outbursts, combativeness). For F01.C18, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for F01.C18 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 in detail (e.g., wandering, verbal outbursts, combativeness)
  • •Use this code only when behavioral disturbance is not agitation, psychotic, mood, or anxiety-related

Clinical Significance

Vascular dementia, severe, with other behavioral disturbance reflects cognitive decline due to cerebrovascular pathology, classified at the severe stage with behavioral disturbance other than agitation (e.g., wandering, sleep disturbance, hoarding, inappropriate social behavior). 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 the specific behavioral disturbance type, such as wandering, sleep-wake cycle disruption, disinhibition, or repetitive behaviors.
  • ✓(4) Document the impact on activities of daily living, need for supervision, and current medication management.

Use Additional Code

  • code, if applicable, to identify wandering in vascular dementia (Z91.83)

Child Codes

F01.C11Vascular dementia, severe, with agitation
HCC 125
F01.C18Vascular dementia, severe, with other behavioral disturbance
HCC 125

Code Hierarchy

└F01Vascular dementia└F01.CVascular dementia, severe└F01.C1Vascular dementia, severe, with behavioral disturbance└F01.C18Vascular dementia, severe, with other behavioral disturbance
└F01.C18Vascular dementia, severe, with other behavioral disturbance

F01.C18 code history

Code setChange
FY2023 (effective Oct 1, 2022)Added to the code set

Source: official CMS ICD-10-CM order and addenda files, FY2016 through FY2027.

Also searched as

  • F01 C18
  • F01C18

For F01.C18, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

F01.C18 maps to CMS-HCC V28 category 125, Dementia, Severe. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies a payment HCC category for F01.C18. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

More on F01.C18

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