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2025 ICD-10-CM code F02.C

Severe dementia in other diseases classified elsewhere.

Always code the underlying physiological condition first. Do not use this code for dementia associated with alcohol or substance use (F10-F19 with .17, .27, .97) or vascular dementia (F01.-).

The medical necessity for care related to F02.C should be justified by the severity of the dementia and its impact on the patient's functioning and quality of life. Documentation should demonstrate the need for services such as cognitive therapy, medication management, or other supportive care.

Clinicians must document the severity of dementia and link it to the identified underlying physiological cause. They should perform a thorough assessment of cognitive function, daily living skills, and behavioral changes.

IMPORTANT:Use F01.C- for severe vascular dementia, F03.C- for severe unspecified dementia, and code first the underlying physiological condition, such as Alzheimer's (G30.-), Creutzfeldt-Jakob disease (A81.0-), epilepsy (G40.-), HIV disease (B20), Huntington's disease (G10), multiple sclerosis (G35), Parkinson's disease (G20.-), traumatic brain injury (S06.-) or other relevant codes.

In simple words: This code indicates a severe form of dementia caused by a physical illness or condition, not including the more common types like Alzheimer's or vascular dementia. The specific cause of the dementia needs to be diagnosed and coded separately.

Dementia in other diseases classified elsewhere, severe. This code signifies severe dementia resulting from a diagnosed physiological condition other than those specifically listed elsewhere in the ICD-10-CM. The underlying physiological condition should be coded first.

Example 1: A patient with severe Huntington's disease (G10) exhibits profound cognitive decline, including memory loss, disorientation, and inability to perform self-care, qualifying as severe dementia., A patient with severe traumatic brain injury (S06.-) develops substantial and progressive cognitive impairment consistent with severe dementia, impacting their ability to function independently., A patient with advanced multiple sclerosis (G35) presents with severe cognitive impairment, impacting daily functioning to the extent that meets the criteria for severe dementia.

Clinicians must provide comprehensive documentation supporting the diagnosis of severe dementia, including details of cognitive assessments, functional limitations, behavioral changes, and the relationship to the underlying physiological condition.

** This code helps in tracking the prevalence and impact of dementia caused by various medical conditions, aiding in research, resource allocation, and treatment planning. As of November 30, 2024, this information is current, but it's always recommended to consult the latest ICD-10-CM guidelines for the most up-to-date information.

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