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F03.C1 ICD-10-CM Code: Unspecified dementia, severe, with behavioral disturbance

Compare with another codeCheck this code on a claim

Billing Status: NO. This is a non-billable ICD-10-CM code: report a more specific billable code beneath it.

Coding at a Glance

Tabular directives
2 Excludes2

Not billable · FY2027A non-billable heading in the tabular list: report a more specific code beneath it.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too; the Instructions section marks which is which.

Excludes2Not included here; may be reported together
  • dementia with delirium or acute confusional state (F05)
  • mild memory disturbance due to known physiological condition (F06.8)

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for F03.C1 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.C1 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.C1

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

Before you code F03.C1

  1. F03.C1 is not reportable as written. Select the more specific code beneath it that the documentation supports. Codes are reported to the highest level of specificity the classification provides (Guidelines I.B.2).

    ReviewF03.C11, F03.C18

    See the relationships section · Guide: How to choose an ICD-10-CM code →

  2. Unspecified does not mean incorrect. When the record gives no greater specificity, F03.C1 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) →

  3. F03.C1’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 documentation support one of the more specific codes beneath F03.C1?
    Yes → Select that code and continue the checks below on its own page.
    No → F03.C1 cannot be reported as written; query for the specificity its subcategory needs.

    ReviewF03.C11, F03.C18

  2. Does the record document the detail a more specific sibling code needs?
    Yes → Review the specific siblings in this subcategory.
    No → Continue — F03.C1 is appropriate when the documentation goes no further.

Consider F03.C1. 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.C1(2 notes)

    Coding workflow: The conditions named in this note are not included in F03.C1. 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.C1 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.C1 with…

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

The codes most likely to be picked instead of F03.C1 — 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.C1 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.C1 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.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Unspecified dementia, severe, with behavioral disturbance is a non-billable ICD-10-CM category code (F03.C1). A more specific billable subcode must be selected for claims submission.

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

Verify Before Coding

  • Not billable as written — a more specific code is required: F03.C11, F03.C18.

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-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name F03.C1 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.C.-).

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.

Contextual Map

Every relationship of F03.C1 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.C1 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

Nearest codes (32)

Change history

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Common coding questions

MedCoder editorial

Can F03.C1 be billed directly?

No. F03.C1 (Unspecified dementia, severe, with behavioral disturbance) is a non-billable ICD-10-CM category code. A more specific billable subcode must be selected based on clinical documentation.

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
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) 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-derived 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 editorial 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.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 20, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

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.C1 — Unspecified dementia, severe, with behavioral disturbance." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/f03.c1-unspecified-dementia-severe-with-behavioral-disturbance

Change history

  • FY2023 — October 1, 2022
    Added to the code set
    Unspecified dementia, severe, with behavioral disturbance
    FY2023 changes

Nearest Codes in This Family

Official ICD-10-CM classifications closest to F03.C1 in its code family, with their registry titles.

View all codes in the F03 family