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F03.B18 ICD-10-CM Code: Unspecified dementia, moderate, with other behavioral disturbance

F03.B18 maps to CMS-HCC V28 126 (RAF 0.341). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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

F03.B18

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

Unspecified dementia, moderate, with other behavioral disturbance

Mid-stage dementia of unknown type with behavioral problems such as wandering, inappropriate conduct, or verbal outbursts.

Buddy the Bee presenting code insight

Buddy Insight

Unspecified dementia, moderate, with other behavioral disturbance represents cognitive decline of moderate severity with behavioral disturbance other than agitation (e.

CMS-HCC V28

HCC 126

RAF 0.341

CMS-HCC V24

HCC 51

RAF 0.346

ACA/HHS

N/A

—

Not mapped

ESRD/PACE

HCC 51

RAF 0.042

RXHCC

HCC 112

Not separately weighted

Code Book Path

Official
F03.BUnspecified dementia, moderate
F03.B1Unspecified dementia, moderate, with behavioral disturbance
F03.B18Unspecified dementia, moderate, with other behavioral disturbance

Inclusion Terms

Official
  • Unspecified dementia, moderate, with behavioral disturbances such as sleep disturbance, social disinhibition, or sexual disinhibition

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for F03.B18 in this effective period.

Related Child Codes

Official
F03.B11Unspecified dementia, moderate, with agitation

Includes

Official

ICD-10-CM does not list Includes notes for F03.B18 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for F03.B18 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for F03.B18 in this effective period.

Use Additional

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

Code Also

Official

ICD-10-CM does not list Code Also instructions for F03.B18 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Documentation must specify: (1) the dementia type and underlying etiology — F03 codes should only be used when the provider has not identified a specific etiology
query the provider to determine if a more specific dementia type can be documented to improve coding accuracy. (2) Severity must be clearly stated as moderate 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 — F03 codes should only be used when the provider has not identified a specific etiology
query the provider to determine if a more specific dementia type can be documented to improve coding accuracy. (2) Severity must be clearly stated as moderate 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
Defaulting to unspecified dementia (F03) when the provider has documented a specific etiology elsewhere in the record — always review the full chart for underlying causes such as Alzheimer disease, cerebrovascular disease, or Parkinson disease. 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. Misassigning dementia severity — the moderate severity level maps to V28 HCC 126 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
F03.A0-F03.A4: Unspecified dementia, mild — lower severity; ensure staging supports moderate classification
F03.C0-F03.C4: Unspecified dementia, severe — higher severity; verify cognitive testing
F02.B0-F02.B4: Dementia in other diseases, moderate — use when underlying etiology is known
F01.B0-F01.B4: Vascular dementia, moderate — use when etiology is cerebrovascular disease

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 F03.B18 an HCC code?

Yes. F03.B18 (Unspecified dementia, moderate, with other behavioral disturbance) maps to Dementia, Moderate under the CMS-HCC V28 risk adjustment model (and Dementia With Complications under V24), with a community non-dual aged RAF of 0.341. It is billable for payment year 2026.

Coder answer: F03.B18 is billable and maps to V28 HCC 126, Dementia, Moderate. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
F03.B18
Description
Unspecified dementia, moderate, with other behavioral disturbance
HCC (V28)
HCC 126 — Dementia, Moderate
RAF
0.341
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 126, Dementia, Moderate
0.341
V24HCC 51, Dementia With Complications
0.346
ESRDHCC 51, Dementia With Complications
0.042
RxHCCHCC 112, Dementia and Other Specified Brain Disorders
Not separately weighted

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work F03.B18 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for F03.B18

For F03.B18 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 F03.B18 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

F03.B18 is the ICD-10-CM diagnosis code for unspecified dementia, moderate, with other behavioral disturbance. Mid-stage dementia of unknown type with behavioral problems such as wandering, inappropriate conduct, or verbal outbursts. F03.B18 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, F03.B18 maps to Dementia, Moderate (HCC 126) with a community, non-dual, aged base RAF weight of 0.341. Under the older CMS-HCC V24 model, F03.B18 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 specific behavioral symptoms beyond agitation to justify this code. Because F03.B18 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 F03.B18 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Document specific behavioral symptoms beyond agitation to justify this code
  • •Consider safety measures and care plan modifications related to the behavioral disturbances

Clinical Significance

Unspecified dementia, moderate, with other behavioral disturbance represents cognitive decline of moderate severity with behavioral disturbance other than agitation (e.g., wandering, sleep disturbance, hoarding, inappropriate social behavior), where the underlying cause has not been determined. This diagnosis carries important implications for patient safety, functional status, and caregiver burden. Providers should be queried for a more specific etiology whenever possible, as unspecified dementia may indicate incomplete workup rather than truly idiopathic disease.

Documentation Requirements

  • ✓Documentation must specify: (1) the dementia type and underlying etiology — F03 codes should only be used when the provider has not identified a specific etiology
  • ✓query the provider to determine if a more specific dementia type can be documented to improve coding accuracy. (2) Severity must be clearly stated as moderate 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 unspecified dementia (Z91.83)

Commonly Confused Codes

  • •F03.A0-F03.A4: Unspecified dementia, mild: lower severity; ensure staging supports moderate classification
  • •F03.C0-F03.C4: Unspecified dementia, severe: higher severity; verify cognitive testing
  • •F02.B0-F02.B4: Dementia in other diseases, moderate: use when underlying etiology is known
  • •F01.B0-F01.B4: Vascular dementia, moderate: use when etiology is cerebrovascular disease
  • •R41.81: Age-related cognitive decline: not a dementia diagnosis

Child Codes

F03.B11Unspecified dementia, moderate, with agitation
HCC 126
F03.B18Unspecified dementia, moderate, with other behavioral disturbance
HCC 126

Code Hierarchy

└F03Unspecified dementia└F03.BUnspecified dementia, moderate└F03.B1Unspecified dementia, moderate, with behavioral disturbance└F03.B18Unspecified dementia, moderate, with other behavioral disturbance
└F03.B18Unspecified dementia, moderate, with other behavioral disturbance

F03.B18 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.

Because F03.B18 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.

F03.B18 maps to CMS-HCC V28 category 126, Dementia, Moderate. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because F03.B18 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

More on F03.B18

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