F02.C11 ICD-10-CM Code: Dementia in other diseases classified elsewhere, severe, with agitation

Code

F02.C11

Description

Dementia in other diseases classified elsewhere, severe, with agitation

HCC (V28)

HCC 125 — Dementia, Severe

RAF reference coefficient

0.341

Billable

Yes

Payment year

2026

HCC Category Mapping

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 F02.C11 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for F02.C11

What This Code Means

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for F02.C11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

• •Always code the underlying disease first, then this dementia code as a secondary diagnosis
• •Agitation must be documented; if other behavioral symptoms are present, consider F02.C18 instead

Clinical Significance

Dementia in other diseases classified elsewhere, severe, with agitation represents cognitive deterioration secondary to an underlying medical condition, at the severe stage with agitation (e.g., restlessness, pacing, verbal or physical aggression). This code captures the dementia manifestation of systemic or neurological diseases such as Parkinson disease, Lewy body disease, Huntington disease, HIV, or prion disease. Proper identification of both the underlying etiology and the dementia severity with associated symptoms is critical for treatment planning and risk stratification.

Documentation Requirements

• ✓Documentation must specify: (1) the dementia type and underlying etiology — F02 codes require a code-first relationship — the underlying condition (e.g., Parkinson disease, Huntington disease, HIV, traumatic brain injury) must be sequenced before the F02 code.
• ✓(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.

Child Codes