F03.B4
BillableUnspecified dementia, moderate, with anxiety
HCC Category Mapping
V28HCC 126 — Dementia, Moderate
0.550RxHCCHCC 112 — Dementia and Other Specified Brain Disorders
0.000What This Code Means
A moderate stage of dementia where the person experiences significant cognitive decline along with anxiety symptoms such as worry, nervousness, or panic.
Coding Tips
- •Verify that anxiety is documented as a behavioral or psychological symptom accompanying the dementia
- •Confirm the dementia severity is documented as moderate, not mild or severe
Clinical Significance
This code captures moderate unspecified dementia with anxiety, representing significant cognitive impairment that affects the patient's functional status and care needs. Moderate dementia carries substantial risk adjustment weight because these patients require intensive care coordination, caregiver support, and monitoring for complications. Accurate severity staging and behavioral documentation directly impact both clinical management and appropriate resource allocation.
Documentation Requirements
- ✓Provider documentation explicitly stating dementia severity as 'moderate'
- ✓Cognitive assessment results (e.g., MMSE, MoCA, or SLUMS score) supporting the stated severity level
- ✓Functional status assessment documenting impact on activities of daily living
- ✓Statement that underlying etiology is unknown or unspecified (if a known cause exists, use a more specific dementia code)
- ✓Documentation of anxiety symptoms as a manifestation of the dementia process, not a separate anxiety disorder
Commonly Confused Codes
F03.B0 — Unspecified dementia, moderate, without behavioral disturbance; use when no behavioral/psychiatric symptoms are presentF03.C4 — Unspecified dementia, severe, with anxiety; differs in severity level — verify cognitive testing supports moderate vs. severeF03.A4 — Unspecified dementia, mild, with anxiety; lower severity — ensure documentation supports moderate stagingF01.C0 through F01.C4 — Vascular dementia, severe; use when documentation attributes dementia to cerebrovascular diseaseF02.C0 through F02.C4 — Dementia in other diseases classified elsewhere, severe; use when a known underlying condition causes the dementia (code underlying condition first)G30.9 with F02 codes — Alzheimer disease with dementia; use F02 codes when Alzheimer is the documented cause
Code Hierarchy
└F03Unspecified dementia└F03.BUnspecified dementia, moderate└F03.B4Unspecified dementia, moderate, with anxiety
└F03.B4Unspecified dementia, moderate, with anxiety