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F03.B4 ICD-10-CM Code: Unspecified dementia, moderate, with anxiety

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
2 Excludes2
Risk adjustment
CMS-HCC V28: 1 category · RxHCC V08 category 112

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 884 — ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY (MDC 19)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 126 — Dementia, Moderate (supersedes HCC 127)

Other models: RxHCC V08 HCC 112

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for F03.B4 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on F03.B4 itself; “inherited from” names the category or block whose note applies here.

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from F03

Coder workflow for F03.B4

MedCoder structured workflow — derived from this code’s own official record

Before you code F03.B4

  1. Unspecified does not mean incorrect. When the record gives no greater specificity, F03.B4 may be the appropriate code. Check the record for detail that supports a more specific sibling — in this subcategory the siblings differ by severity, the presence or absence of the associated condition. An unspecified code is for records that do not provide the detail a more specific code needs; a query, not an assumption, is the route to specificity (Guidelines I.A.9.b, I.B.18).

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. F03.B4’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

Choose the right path

  1. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — F03.B4 is appropriate when the documentation goes no further.

Consider F03.B4. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Severity
Mild, moderate or severe as the provider states it; severity is not inferred from the clinical picture.
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes2 — not part of F03.B4(2 notes)

    Coding workflow: The conditions named in this note are not included in F03.B4. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareF05, F06.8

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: The provider documents the condition in the terms of this code’s title and records no further detail.

Coding question: Is a more specific sibling code supportable?

Path: Review the subcategory for a sibling that names the missing detail.

Reason: A more specific code needs documentation of the distinguishing element; without it the unspecified code is appropriate, and a provider query is the route to specificity (Guidelines I.A.9.b, I.B.18).

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is F03.B4 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse F03.B4 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of F03.B4 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • F05— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of dementia with delirium or acute confusional state adds F05; it is not part of this code and both may be reported when both are documented.

    Full comparison: F03.B4 vs F05 →

  • F06.8— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of mild memory disturbance due to known physiological condition adds F06.8; it is not part of this code and both may be reported when both are documented.

    Full comparison: F03.B4 vs F06.8 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Code Overview

Unspecified dementia, moderate, with anxiety is a billable ICD-10-CM diagnosis code (F03.B4).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (1)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01 – F99)

d. Dementia The ICD-10-CM classifies dementia (categories F01, F02, and F03) on the basis of the etiology and severity (unspecified, mild, moderate or severe). Selection of the appropriate severity level requires the provider’s clinical judgment and codes should be assigned only on the basis of provider documentation (as defined in the Official Guidelines for Coding and Reporting), unless otherwise instructed by the classification. If the documentation does not provide information about the severity of the dementia, assign the appropriate code for unspecified severity.

Verify Before Coding

  • Age-restricted: the Medicare Code Editor lists this as an adult (age 15-124) diagnosis; other ages are presumed incorrect.
  • CC as a secondary diagnosis (FY2027). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name F03.B4 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 5 Excludes1 notes across 3 chapters: F06 — Other mental disorders due to known physiological condition (via F03.-), F06.7 — Mild neurocognitive disorder due to known physiological condition (via F03.-), G30 — Alzheimer's disease (via F03.-), G31.84 — Mild cognitive impairment of uncertain or unknown etiology (via F03.-), R54 — Age-related physical debility (via F03.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 2 Excludes2 notes: F63.1 — Pyromania (via F03.-), F63.2 — Kleptomania (via F03.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 1 Code First instruction: Z91.83 — Wandering in diseases classified elsewhere (via F03.B.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 20 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 1 MS-DRG: DRG 884 (MDC 19).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):NVS011 — Neurocognitive disorders (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

F03.911 — Unspecified dementia, unspecified severity, with agitation, F03.918 — Unspecified dementia, unspecified severity, with other behavioral disturbance, F03.92 — Unspecified dementia, unspecified severity, with psychotic disturbance, F03.93 — Unspecified dementia, unspecified severity, with mood disturbance, F03.94 — Unspecified dementia, unspecified severity, with anxiety, F03.A11 — Unspecified dementia, mild, with agitation, F03.A18 — Unspecified dementia, mild, with other behavioral disturbance, F03.A2 — Unspecified dementia, mild, with psychotic disturbance, F03.A3 — Unspecified dementia, mild, with mood disturbance, F03.A4 — Unspecified dementia, mild, with anxiety, F03.B11 — Unspecified dementia, moderate, with agitation, F03.B18 — Unspecified dementia, moderate, with other behavioral disturbance, F03.B2 — Unspecified dementia, moderate, with psychotic disturbance, F03.B3 — Unspecified dementia, moderate, with mood disturbance, F03.C11 — Unspecified dementia, severe, with agitation, F03.C18 — Unspecified dementia, severe, with other behavioral disturbance, F03.C2 — Unspecified dementia, severe, with psychotic disturbance, F03.C3 — Unspecified dementia, severe, with mood disturbance, F03.C4 — Unspecified dementia, severe, with anxiety

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Dementia, Moderate) for risk-adjusted payment.

F01.B0 — Vascular dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, F01.B11 — Vascular dementia, moderate, with agitation, F01.B18 — Vascular dementia, moderate, with other behavioral disturbance, F01.B2 — Vascular dementia, moderate, with psychotic disturbance, F01.B3 — Vascular dementia, moderate, with mood disturbance, F01.B4 — Vascular dementia, moderate, with anxiety, F02.B0 — Dementia in other diseases classified elsewhere, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, F02.B11 — Dementia in other diseases classified elsewhere, moderate, with agitation, F02.B18 — Dementia in other diseases classified elsewhere, moderate, with other behavioral disturbance, F02.B2 — Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance, F02.B3 — Dementia in other diseases classified elsewhere, moderate, with mood disturbance, F02.B4 — Dementia in other diseases classified elsewhere, moderate, with anxiety, F03.B0 — Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, F03.B11 — Unspecified dementia, moderate, with agitation, F03.B18 — Unspecified dementia, moderate, with other behavioral disturbance, F03.B2 — Unspecified dementia, moderate, with psychotic disturbance, F03.B3 — Unspecified dementia, moderate, with mood disturbance

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Dementia, Severe, Dementia, Mild or Unspecified

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Neurocognitive disorders).

F03.A11 — Unspecified dementia, mild, with agitation, F03.A18 — Unspecified dementia, mild, with other behavioral disturbance, F03.A2 — Unspecified dementia, mild, with psychotic disturbance, F03.A3 — Unspecified dementia, mild, with mood disturbance, F03.A4 — Unspecified dementia, mild, with anxiety, F03.B0 — Unspecified dementia, moderate, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, F03.B11 — Unspecified dementia, moderate, with agitation, F03.B18 — Unspecified dementia, moderate, with other behavioral disturbance, F03.B2 — Unspecified dementia, moderate, with psychotic disturbance, F03.B3 — Unspecified dementia, moderate, with mood disturbance, F03.C0 — Unspecified dementia, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety, F03.C11 — Unspecified dementia, severe, with agitation, F03.C18 — Unspecified dementia, severe, with other behavioral disturbance, F03.C2 — Unspecified dementia, severe, with psychotic disturbance, F03.C3 — Unspecified dementia, severe, with mood disturbance, F03.C4 — Unspecified dementia, severe, with anxiety, F04 — Amnestic disorder due to known physiological condition, F05 — Delirium due to known physiological condition, F06.70 — Mild neurocognitive disorder due to known physiological condition without behavioral disturbance, F06.71 — Mild neurocognitive disorder due to known physiological condition with behavioral disturbance, +77 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Dementia”; these codes share that main term but sit in a different category of the Tabular List.

F02.B18 — Dementia in other diseases classified elsewhere, moderate, with other behavioral disturbance (in, diseases specified elsewhere, moderate, with, behavioral disturbances), F02.B2 — Dementia in other diseases classified elsewhere, moderate, with psychotic disturbance (in, diseases specified elsewhere, moderate, with, psychotic disturbance), F02.B3 — Dementia in other diseases classified elsewhere, moderate, with mood disturbance (in, diseases specified elsewhere, moderate, with, mood disturbance), F02.B4 — Dementia in other diseases classified elsewhere, moderate, with anxiety (in, diseases specified elsewhere, moderate, with, anxiety), F02.C0 — Dementia in other diseases classified elsewhere, severe, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety (in, diseases specified elsewhere, severe), F02.C11 — Dementia in other diseases classified elsewhere, severe, with agitation (in, diseases specified elsewhere, severe, with, agitation), F02.C18 — Dementia in other diseases classified elsewhere, severe, with other behavioral disturbance (in, diseases specified elsewhere, severe, with, behavioral disturbances), F02.C2 — Dementia in other diseases classified elsewhere, severe, with psychotic disturbance (in, diseases specified elsewhere, severe, with, psychotic disturbance), F02.C3 — Dementia in other diseases classified elsewhere, severe, with mood disturbance (in, diseases specified elsewhere, severe, with, mood disturbance), F02.C4 — Dementia in other diseases classified elsewhere, severe, with anxiety (in, diseases specified elsewhere, severe, with, anxiety), F05 — Delirium due to known physiological condition (with, acute confusional state), F10.27 — Alcohol dependence with alcohol-induced persisting dementia (alcoholic, with dependence), F10.97 — Alcohol use, unspecified with alcohol-induced persisting dementia (alcoholic), F13.27 — Sedative, hypnotic or anxiolytic dependence with sedative, hypnotic or anxiolytic-induced persisting dementia (in, sedatives, hypnotics or anxiolytics, with dependence), F13.97 — Sedative, hypnotic or anxiolytic use, unspecified with sedative, hypnotic or anxiolytic-induced persisting dementia (in, sedatives, hypnotics or anxiolytics), F18.27 — Inhalant dependence with inhalant-induced dementia (in, inhalants, with dependence), F18.97 — Inhalant use, unspecified with inhalant-induced persisting dementia (in, inhalants), F19.27 — Other psychoactive substance dependence with psychoactive substance-induced persisting dementia (in, psychoactive drug, with dependence), F19.97 — Other psychoactive substance use, unspecified with psychoactive substance-induced persisting dementia (in, psychoactive drug), F84.3 — Other childhood disintegrative disorder (infantile, infantilis), +58 more

Contextual Map

Every relationship of F03.B4 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run F03.B4 with these 8 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

  • F63.1 — Pyromania[Excludes2](via F03.-): “mental disorders due to known physiological condition (F01-F09)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027
  • F63.2 — Kleptomania[Excludes2](via F03.-): “stealing in mental disorders due to known physiological condition (F01-F09)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2027

Referenced by Code First instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 126 — Dementia, Moderate [CMS-HCC]: “Dementia, Moderate — supersedes HCC 127 (Dementia, Mild or Unspecified)”— CMS-HCC V28 · 2026

MS-DRG Grouper

  • CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2027
  • DRG 884 — ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY[MS-DRG]: “ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY (MDC 19)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2027

MDC crossing

  • MDC 19 — Mental Diseases and Disorders[MDC crossing]: “Mental Diseases and Disorders — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Dementia (degenerative (primary)) (persisting) (unspecified severity) (without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety), moderate, with, anxiety[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes (32)

Change history

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Coding guidelines Official source data
ICD-10-CM Official Guidelines for Coding and Reporting (FY2027), quoted by section Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "F03.B4 — Unspecified dementia, moderate, with anxiety." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/f03.b4-unspecified-dementia-moderate-with-anxiety

Change history

  • FY2023 — October 1, 2022
    Added to the code set
    Unspecified dementia, moderate, with anxiety
    FY2023 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to F03.B4 in its code family, with their registry titles.

View all codes in the F03 family