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v1.0.0
ICD-10 Guide
ICD-10 CodesR73.03

R73.03

Prediabetes

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R73.03 is a billable code used to indicate a diagnosis of prediabetes.

Key Diagnostic Point:

Prediabetes is a metabolic condition characterized by elevated blood glucose levels that are not high enough to be classified as diabetes mellitus. It is often identified through abnormal laboratory findings, such as fasting plasma glucose levels between 100-125 mg/dL, an oral glucose tolerance test result of 140-199 mg/dL, or a hemoglobin A1c level between 5.7% and 6.4%. Patients may not exhibit overt symptoms, but they are at increased risk for developing type 2 diabetes, cardiovascular disease, and other metabolic disorders. Common signs include insulin resistance, which may manifest as acanthosis nigricans, and patients may report fatigue or increased thirst. The condition is often asymptomatic, making routine screening essential for early detection and intervention. Lifestyle modifications, including diet and exercise, are critical in managing prediabetes and preventing progression to diabetes.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in laboratory test results and interpretation
  • Need for comprehensive patient history to establish risk factors
  • Potential overlap with other glucose metabolism disorders
  • Documentation of lifestyle factors and interventions

Audit Risk Factors

  • Inadequate documentation of laboratory findings
  • Failure to document risk factors or lifestyle interventions
  • Misclassification of prediabetes as diabetes
  • Lack of follow-up documentation for management plans

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed documentation of patient history, risk factors, and laboratory results is essential. Providers should note any lifestyle modifications or referrals to dietitians.

Common Clinical Scenarios

Routine screening in adults with risk factors such as obesity, family history of diabetes, or hypertension.

Billing Considerations

Consideration of comorbid conditions that may affect glucose metabolism.

Emergency Medicine

Documentation Requirements

Acute care documentation should include any presenting symptoms, vital signs, and immediate lab results.

Common Clinical Scenarios

Patients presenting with symptoms of hyperglycemia or related complications.

Billing Considerations

Emergency settings may require rapid assessment and intervention, necessitating clear documentation of findings.

Coding Guidelines

Inclusion Criteria

Use R73.03 When
  • Coders should follow the official ICD
  • CM guidelines for coding and reporting, ensuring accurate documentation of laboratory findings and patient history
  • The diagnosis should be supported by clinical evidence and follow
  • up plans

Exclusion Criteria

Do NOT use R73.03 When
No specific exclusions found.

Related CPT Codes

82947CPT Code

Glucose; quantitative, blood (except reagent strip)

Clinical Scenario

Used when performing glucose testing to confirm prediabetes diagnosis.

Documentation Requirements

Document the reason for the test and the results.

Specialty Considerations

Internal medicine may require additional lifestyle counseling documentation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of prediabetes, improving the ability to track and manage this condition effectively. It emphasizes the importance of accurate documentation and coding practices.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of prediabetes, improving the ability to track and manage this condition effectively. It emphasizes the importance of accurate documentation and coding practices.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    American Diabetes Association - Standards of Medical Care in Diabetes

Coding & Billing References

  • •
    American Diabetes Association - Standards of Medical Care in Diabetes

Frequently Asked Questions

What laboratory tests are used to diagnose prediabetes?

Prediabetes can be diagnosed using fasting plasma glucose tests, oral glucose tolerance tests, or hemoglobin A1c tests. Each test has specific thresholds for diagnosis.

How often should patients be screened for prediabetes?

Patients at high risk for diabetes should be screened at least annually, while those with normal glucose levels may be screened every 3 years.