ICD-10 Coding for Prediabetes, Borderline Diabetes, or Impaired Fasting Glucose
The recommended ICD-10 code for prediabetes, borderline diabetes, or impaired fasting glucose is R73.03 (Prediabetes). This is the most appropriate code to use for patients who meet the clinical criteria for prediabetes according to current diagnostic standards 1.
Diagnostic Criteria for Prediabetes
Prediabetes is clinically defined by one or more of the following criteria 1:
- A1C: 5.7-6.4% (39-47 mmol/mol)
- Fasting Plasma Glucose (IFG): 100-125 mg/dL (5.6-6.9 mmol/L)
- 2-hour Plasma Glucose during 75-g OGTT (IGT): 140-199 mg/dL (7.8-11.0 mmol/L)
Coding Considerations
When coding for prediabetes, consider the following:
Use R73.03 (Prediabetes) as the primary code for patients with:
- Impaired fasting glucose
- Impaired glucose tolerance
- Borderline diabetes
- Prediabetes
Do not use diabetes codes (E08-E13) for prediabetic conditions, as these are reserved for diagnosed diabetes mellitus 1.
Avoid using R73.01 (Impaired fasting glucose) or R73.02 (Impaired glucose tolerance) separately, as R73.03 encompasses both conditions and is the preferred comprehensive code 1.
Clinical Importance of Proper Coding
Accurate coding is important for several reasons:
- Patient care: Proper coding ensures appropriate follow-up and monitoring for patients at risk for diabetes progression
- Risk stratification: Identifies patients who need more intensive lifestyle interventions
- Quality measures: Facilitates population health management for prediabetes
- Research: Enables accurate data collection for epidemiological studies
Monitoring Recommendations for Coded Patients
Patients coded with R73.03 should receive 1:
- At least annual monitoring for progression to diabetes
- Referral to intensive diet and physical activity behavioral counseling
- Consideration of metformin therapy for high-risk individuals (BMI >35 kg/m², age <60 years, women with prior gestational diabetes)
Common Pitfalls to Avoid
- Don't use E11.9 (Type 2 diabetes) for prediabetic states - this is incorrect and may lead to improper treatment
- Don't use R73.9 (Hyperglycemia, unspecified) when prediabetes is clearly documented
- Don't use multiple codes (R73.01 and R73.02) when R73.03 is sufficient
Special Considerations
For pregnant women with prediabetes who require monitoring during pregnancy, consider using:
- R73.03 (Prediabetes) as the primary diagnosis
- Z33.1 (Pregnant state, incidental) as a secondary diagnosis
This combination accurately reflects the patient's prediabetic state while acknowledging the pregnancy context that may affect management decisions 2.