What is ICD-10 code F01.C2?

F01.C2 is the ICD-10-CM diagnosis code for Vascular dementia, severe, with psychotic disturbance. It belongs to the ICD-10-CM chapter for mental, behavioral and neurodevelopmental disorders (f01-f99). F01.C2 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. F01.C2 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. F01.C2 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. F01.C2 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for F01.C2?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. F01.C2 is a payment HCC under V28 (Dementia, Severe) but was not retained as a payment HCC under V24. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting F01.C2?

Verify documentation clearly states both 'vascular dementia' and 'severe' stage along with presence of psychotic disturbance (hallucinations, delusions, or paranoia) before assigning this code Ensure the psychotic disturbance is directly related to the vascular dementia and not a separate psychiatric condition; if uncertain, query the provider for clarification Because F01.C2 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

F01.C2 ICD-10 Code: Vascular dementia, severe

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupF01.C2Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

F01.C2

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

Vascular dementia, severe, with psychotic disturbance

This code describes a severe form of dementia caused by reduced blood flow to the brain, where the patient also experiences psychotic symptoms such as hallucinations or delusions. This is the most advanced stage of vascular dementia with significant cognitive decline and psychiatric complications.

Buddy Insight

CMS-HCC V28

Mapped

HCC 125

Dementia, Severe

RAF 0.885

CMS-HCC V24

Not risk-adjusted for this model/period.

RAF 0

ACA/HHS

Not risk-adjusted for this model/period.

RAF 0

ESRD/PACE

Not risk-adjusted for this model/period.

RAF 0

RXHCC

Mapped

HCC 112

Dementia and Other Specified ...

RAF 0.0

Code Trumping

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Code Book Path

Official

F01Vascular dementia

F01.CVascular dementia, severe

F01.C2Vascular dementia, severe, with psychotic disturbance

Inclusion Terms

Official

Major neurocognitive disorder due to vascular disease, severe, with psychotic disturbance such as hallucinations, paranoia, suspiciousness, or delusional state
Vascular dementia, severe, with psychotic disturbance such as hallucinations, paranoia, suspiciousness, or delusional state

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F01.C2 in this effective period.

Related Child Codes

Official

F01.C0Vascular dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety

F01.C1Vascular dementia, severe, with behavioral disturbance

F01.C3Vascular dementia, severe, with mood disturbance

F01.C4Vascular dementia, severe, with anxiety

Includes

Official

ICD-10-CM does not list Includes notes for F01.C2 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F01.C2 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F01.C2 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for F01.C2 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for F01.C2 in this effective period.

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 type of psychotic features present — visual hallucinations, auditory hallucinations, paranoid delusions, or misidentification syndromes — and confirm they are attributable to the dementia rather than a primary psychiatric disorder.

(4) Document the impact on activities of daily living, need for supervision, and current medication management.

MEAT Support

HCC Buddy guidance

(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).

(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). Separately coding a psychotic disorder (e.g., F06.2) when the psychotic symptoms are a direct manifestation of the dementia — the combination code captures both. Misassigning dementia severity — the severe severity level maps to V28 HCC 125 with RAF 0.

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.

Common Mistakes

HCC Buddy guidance

F01.C0: Vascular dementia, severe, without behavioral disturbance — use when no behavioral, psychotic, mood, or anxiety symptoms are present

F01.B0-F01.B4: Vascular dementia, moderate — lower severity stage; confirm cognitive testing supports severe classification

F02.C0-F02.C4: Dementia in other diseases, severe — use only when dementia is secondary to a non-vascular underlying condition

G30.9: Alzheimer disease, unspecified — distinct etiology from vascular dementia; mixed dementia requires both codes

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is F01.C2 an HCC code?

Yes. F01.C2 maps to Dementia, Severe under the CMS-HCC V28 risk adjustment model.

HCC Category Mapping

V28HCC 125, Dementia, Severe

0.885

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.C2

For F01.C2to 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.C2 during that encounter, not just copy-forwarded from a problem list.

What This Code Means

F01.C2 is the ICD-10-CM diagnosis code for vascular dementia, severe, with psychotic disturbance. This code describes a severe form of dementia caused by reduced blood flow to the brain, where the patient also experiences psychotic symptoms such as hallucinations or delusions. This is the most advanced stage of vascular dementia with significant cognitive decline and psychiatric complications. F01.C2 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.C2 maps to Dementia, Severe (HCC 125) with a community, non-dual, aged base RAF weight of 0.885. F01.C2 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.

Verify documentation clearly states both 'vascular dementia' and 'severe' stage along with presence of psychotic disturbance (hallucinations, delusions, or paranoia) before assigning this code. Because F01.C2 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.C2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify documentation clearly states both 'vascular dementia' and 'severe' stage along with presence of psychotic disturbance (hallucinations, delusions, or paranoia) before assigning this code
•Ensure the psychotic disturbance is directly related to the vascular dementia and not a separate psychiatric condition; if uncertain, query the provider for clarification

Clinical Significance

Vascular dementia, severe, with psychotic disturbance reflects cognitive decline due to cerebrovascular pathology, classified at the severe stage with psychotic features such as hallucinations or delusions. 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 type of psychotic features present — visual hallucinations, auditory hallucinations, paranoid delusions, or misidentification syndromes — and confirm they are attributable to the dementia rather than a primary psychiatric disorder.
✓(4) Document the impact on activities of daily living, need for supervision, and current medication management.

Commonly Confused Codes

•F01.C0: Vascular dementia, severe, without behavioral disturbance: use when no behavioral, psychotic, mood, or anxiety symptoms are present
•F01.B0-F01.B4: Vascular dementia, moderate: lower severity stage; confirm cognitive testing supports severe classification
•F02.C0-F02.C4: Dementia in other diseases, severe: use only when dementia is secondary to a non-vascular underlying condition
•G30.9: Alzheimer disease, unspecified: distinct etiology from vascular dementia; mixed dementia requires both codes
•F03.C0-F03.C4: Unspecified dementia, severe: use only when no specific etiology is identified