Prediabetes ICD-10-CM Codes

What ICD-10 Codes are Used for Prediabetes 

Prediabetes poses a significant health risk as it entails elevated blood sugar levels that exceed the normal range but do not meet the criteria for a type 2 diabetes diagnosis. Accurate diagnosis and management of prediabetes can prevent the progression to type 2 diabetes. In the medical field, this condition is represented using specific codes known as ICD-10 codes, which are essential for diagnosis, billing, and treatment purposes.

Here are eight commonly used ICD-10 codes for prediabetes, along with their clinical descriptions:

1. R73.01 - Impaired fasting glucose 

This code represents a condition where fasting blood glucose levels are consistently higher than normal but not high enough to be classified as diabetes.

2. R73.02 - Impaired glucose tolerance (oral) 

This code is used when a patient's body shows a diminished response to consumed glucose, identified by an oral glucose tolerance test.

3. R73.03 - Prediabetes 

This code indicates a diagnosis of prediabetes, a condition where blood sugar levels are elevated but not high enough to be classified as diabetes.

4. R73.09 - Other abnormal glucose 

This code covers other situations where abnormal glucose levels indicate a potential risk of developing diabetes.

5. Z79.4 - Long-term (current) use of insulin 

While this code doesn't directly indicate prediabetes, it is often used in patients treated with insulin to control their blood sugar levels.

6. E13.9 - Other specified diabetes mellitus without complications 

This code is used for types of diabetes that do not fit into other categories, and it can sometimes be used in cases of severe prediabetes.

7. Z83.3 - Family history of diabetes 

This code is used when a patient has a family history of diabetes, significantly increasing their risk of developing prediabetes or diabetes.

8. E66.01 - Morbid (severe) obesity due to excess calories 

As obesity is a crucial risk factor for developing prediabetes, this code may be used with prediabetes codes.

Understanding these codes and their application in practical settings is crucial for healthcare providers. To delve deeper into these topics, refer to this video explainer for an in-depth guide on these codes and their role in diagnosing and managing prediabetes.

For more detailed medical billing and coding insights, especially for conditions like prediabetes, visit our Prediabetes ICD Codes guide. This resource offers a thorough overview of the healthcare coding process and its importance. It's an invaluable tool for anyone interested in understanding the complexities of prediabetes diagnosis and management.

Which Prediabetes ICD codes are Billable

Prediabetes is when blood sugar levels are higher than normal but not high enough to be diagnosed as diabetes. This condition is represented using specific ICD-10 codes for medical billing and reimbursement purposes. Here are some commonly used ICD-10 codes for prediabetes and whether they are billable:

1. R73.01 - Impaired fasting glucose: Yes, this code is billable. 
2. R73.02 - Impaired glucose tolerance (oral): Yes, this code is billable. 
3. R73.03 - Prediabetes: Yes, this code is billable. 
4. R73.09 - Other abnormal glucose: Yes, this code is billable. 
5. Z79.4 - Long-term (current) use of insulin: Yes, this code is billable. 
6. E13.9 - Other specified diabetes mellitus without complications: Yes, this code is billable. 
7. Z83.3 - Family history of diabetes: Yes, this code is billable. 
8. E66.01 - Morbid (severe) obesity due to excess calories: Yes, this code is billable. 

Please note that while these codes are generally considered billable, the specifics may vary depending on the insurance provider's policies. Always verify with the specific payer to confirm their coding guidelines and policies.

Clinical Information

• Prediabetes is a medical condition characterized by blood glucose levels higher than normal but not high enough to be classified as diabetes.
• Often referred to as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG), prediabetes is an intermediate stage in developing type 2 diabetes.
• Individuals with prediabetes are at an increased risk of developing type 2 diabetes, heart disease, and stroke. This makes the condition a serious health concern that requires proactive management.
• One of the challenging aspects of prediabetes is that it typically does not present noticeable symptoms. Many people with prediabetes don't know they have it until they're diagnosed with type 2 diabetes.
• There are several risk factors associated with prediabetes. These include being overweight or obese, aged 45 years or older, having a family history of type 2 diabetes, and leading a sedentary lifestyle. Women who have gestational diabetes or who have polycystic ovary syndrome (PCOS) are also at increased risk.
• Lifestyle modifications are crucial in managing prediabetes and preventing its progression to type 2 diabetes. This includes adopting a healthier diet, engaging in regular physical activity, losing weight, and quitting smoking.
• Regular monitoring of blood sugar levels is essential for people diagnosed with prediabetes. This helps ensure the condition is effectively managed and does not progress to full-blown diabetes.
• Healthcare providers use specific ICD-10 codes in the clinical setting to diagnose and manage prediabetes. These codes include R73.01, R73.02, and R73.03, among others.
• These codes are used for diagnosis and treatment and are critical for medical billing and reimbursement.
• It's important to note that prediabetes is a reversible condition. With early detection, appropriate lifestyle changes, and careful management, individuals with prediabetes can delay or even prevent the development of type 2 diabetes.

Synonyms Include

• Impaired Glucose Tolerance (IGT)
• Impaired Fasting Glucose (IFG)
• Borderline Diabetes
• Early Onset Diabetes
• Subclinical Diabetes