ICD-10 F Codes for Dementia with Behavioral Disturbances
The specific F code for dementia with behavioral disturbances depends on the underlying etiology of the dementia, not simply the presence of behavioral symptoms. The underlying pathology determines the classification, and behavioral disturbances are documented as a modifier to the primary dementia diagnosis 1.
Primary F Code Categories by Etiology
Alzheimer's Disease with Behavioral Disturbances
- F02.81: Dementia in other diseases classified elsewhere with behavioral disturbance 1
- This code is used when Alzheimer's disease (coded separately as G30.x) presents with agitation, aggression, wandering, sexual disinhibition, or other behavioral symptoms 2, 3
- Behavioral symptoms include uncharacteristic mood fluctuations, agitation, impaired motivation, apathy, social withdrawal, and socially unacceptable behaviors 2, 3
Vascular Dementia with Behavioral Disturbances
- F01.51: Vascular dementia with behavioral disturbance 1
- Used when cerebrovascular disease is the primary etiology and behavioral symptoms are present 2
Frontotemporal Dementia with Behavioral Disturbances
- F02.81: Dementia in other diseases classified elsewhere with behavioral disturbance 1
- Particularly relevant given that behavioral symptoms (disinhibition, apathy, loss of empathy, perseverative behavior, hyperorality) are core features present in >50% of patients 4
Lewy Body Dementia with Behavioral Disturbances
- F02.81: Dementia in other diseases classified elsewhere with behavioral disturbance 1
- Commonly presents with fluctuating cognition, visual hallucinations, and behavioral symptoms 2
Unspecified Dementia with Behavioral Disturbances
- F03.91: Unspecified dementia with behavioral disturbance 1
- Used when the underlying etiology cannot be determined or remains unclear after evaluation 1
Key Behavioral Symptoms to Document
Behavioral disturbances occur in 30-90% of dementia patients and should be systematically assessed using validated tools 5, 6:
- Agitation symptoms: Pacing, wandering, verbal aggression, repetitiveness, screaming, hitting, grabbing, sexual advances 3, 5
- Mood disorders: Depression, apathy, euphoria, anxiety 5, 6
- Psychotic symptoms: Delusions and hallucinations (increase in frequency as disease progresses) 3, 5
- Sleep disturbances: Insomnia, hypersomnia, night-day reversal 5, 7
- Personality changes: Loss of empathy, social withdrawal, disinhibition, compulsive behaviors 2, 4
Clinical Documentation Requirements
The diagnostic evaluation must establish the specific underlying pathology before assigning the appropriate F code 1:
- Document whether dementia is due to Alzheimer's disease, vascular pathology, frontotemporal degeneration, Lewy body disease, or another specific process 1
- Use validated assessment tools: NPI-Q for comprehensive behavioral assessment, CMAI for agitation, CSDD for depression, GAI or PSWQ-A for anxiety 3
- Reassess behavioral symptoms at least every 6 months as new behaviors emerge with disease progression 3
- Evaluate for reversible causes: drug toxicity, medical conditions, psychiatric disorders, environmental factors 3
Important Coding Considerations
The ".81" or ".91" modifier specifically indicates the presence of behavioral disturbances and is critical for accurate coding 1:
- Without behavioral disturbances, use F02.80 (dementia without behavioral disturbance) or F03.90 (unspecified dementia without behavioral disturbance) 1
- The primary disease code (e.g., G30.x for Alzheimer's disease) must be listed first, followed by F02.81 1
- Mixed etiology dementia (common in patients >80 years) requires documentation of all contributing pathologies 2