F03.C11

Billable

Unspecified dementia, severe, with agitation

HCC Category Mapping

V28HCC 125 — Dementia, Severe

0.885

RxHCCHCC 112 — Dementia and Other Specified Brain Disorders

0.000

What This Code Means

Severe dementia accompanied by agitation, where the person exhibits restlessness, irritability, or aggressive behavior due to their advanced cognitive decline.

Coding Tips

•Ensure agitation is specifically documented in the clinical notes as a behavioral disturbance
•Confirm severity is documented as severe, not moderate or mild

Clinical Significance

This code captures severe unspecified dementia with agitation, representing significant cognitive impairment that affects the patient's functional status and care needs. Severe 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 'severe'
✓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 agitation behaviors (e.g., verbal or physical aggression, restlessness) as a manifestation of the dementia

Commonly Confused Codes

F03.B0 — Unspecified dementia, moderate, without behavioral disturbance; lower severity level F01.C0 through F01.C4 — Vascular dementia, severe; use when documentation attributes dementia to cerebrovascular disease F02.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.CUnspecified dementia, severe └F03.C1Unspecified dementia, severe, with behavioral disturbance └F03.C11Unspecified dementia, severe, with agitation

└F03.C11Unspecified dementia, severe, with agitation