FY2027 ICD-10-CM reference
F03.C11: Unspecified dementia, severe, with agitation
By the HCC Buddy Coding Team
The official ICD-10-CM descriptor is Unspecified dementia, severe, with agitation. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Billable code. Verified against the official FY2027 order file.
FY2027 Tabular instructions
Instructions below include applicable chapter, section and parent-code notes. Each note identifies where it appears in the official source.
Includes
disorders of psychological development
Source: F01-F99 (chapter, inherited).
Excludes2
symptoms, signs and abnormal clinical laboratory findings, not elsewhere classified (R00-R99)
Source: F01-F99 (chapter, inherited).
Instructional note
This block comprises a range of mental disorders grouped together on the basis of their having in common a demonstrable etiology in cerebral disease, brain injury, or other insult leading to cerebral dysfunction. The dysfunction may be primary, as in diseases, injuries, and insults that affect the brain directly and selectively; or secondary, as in systemic diseases and disorders that attack the brain only as one of the multiple organs or systems of the body that are involved.
Source: F01-F09 (section, inherited).
Instructional note
Major neurocognitive disorder NOS
Source: F03 (category, inherited).
Instructional note
Presenile dementia NOS
Source: F03 (category, inherited).
Instructional note
Presenile psychosis NOS
Source: F03 (category, inherited).
Instructional note
Primary degenerative dementia NOS
Source: F03 (category, inherited).
Instructional note
Senile dementia NOS
Source: F03 (category, inherited).
Instructional note
Senile dementia depressed or paranoid type
Source: F03 (category, inherited).
Instructional note
Senile psychosis NOS
Source: F03 (category, inherited).
Excludes2
dementia with delirium or acute confusional state (F05)
Source: F03 (category, inherited).
Excludes2
mild memory disturbance due to known physiological condition (F06.8)
Source: F03 (category, inherited).
Instructional note
Unspecified dementia, severe, with aberrant motor behavior such as restlessness, rocking, pacing, or exit-seeking
Source: F03.C11 (self, direct).
Instructional note
Unspecified dementia, severe, with verbal or physical behaviors such as profanity, shouting, threatening, anger, aggression, combativeness, or violence
Source: F03.C11 (self, direct).
Compare the FY2027 additions, removals and billable-status changes
What does F03.C11 mean in FY2027?
The official ICD-10-CM descriptor is Unspecified dementia, severe, with agitation. The FY2027 annual edition starts October 1, 2026. Check the edition that applies to the encounter or inpatient discharge, including any April update.
Is F03.C11 billable in FY2027?
The FY2027 order file marks F03.C11 as billable. Check the complete Tabular instructions and documentation before assigning it.
Does F03.C11 map to an HCC?
In the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service), F03.C11 maps to CMS-HCC V28 HCC 125 (Dementia, Severe). This code has a CMS age requirement: applies when age >= 15. For 2027 dates of service, CMS has not yet published the payment year 2028 mappings. Under the PY2026 CMS mapping; CMS 2027 initial file unchanged: ESRD HCC 51 (This code has a CMS age requirement: applies when age >= 15); RxHCC HCC 112 (This code has a CMS age requirement: applies when age >= 15). Coefficients for these models are pending verification for payment year 2027. CMS-HCC V24: not used for payment year 2027 Medicare Advantage payment (CMS CY 2027 Rate Announcement). PACE and HHS-HCC mappings are still pending verification for FY2027.
Source: CMS FY2027 ICD-10-CM order file. Payment model: CMS CY 2027 Rate Announcement. Read the FY2027 Official Guidelines.
Review the FY2026 April edition