F03.C2

Billable

Unspecified dementia, severe, with psychotic disturbance

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 where the person experiences psychotic symptoms such as hallucinations or delusions in addition to their cognitive decline.

Coding Tips

•Ensure psychotic symptoms (hallucinations or delusions) are clearly documented
•Distinguish from other behavioral disturbances; psychotic disturbance is specifically about hallucinations or delusions

Clinical Significance

This code captures severe unspecified dementia with psychotic disturbance, 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 psychotic symptoms (delusions, hallucinations) as a manifestation of the dementia, not a primary psychotic disorder

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.C2Unspecified dementia, severe, with psychotic disturbance

└F03.C2Unspecified dementia, severe, with psychotic disturbance