R73.03 ICD-10-CM Code: Prediabetes

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for R73.03 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on R73.03 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for R73.03

MedCoder structured workflow — derived from this code’s own official record

Before you code R73.03

1. Check whether an established diagnosis that explains this sign or symptom is documented. If one is, review whether the documented diagnosis changes the coding pathway: a symptom that is integral to a confirmed diagnosis is not reported separately, while one not routinely associated with it may be. Signs and symptoms are reported when no definitive diagnosis is established (Guidelines I.B.4, I.B.5, I.B.6, I.C.18.b).

   Guide: Symptom code vs confirmed diagnosis →

2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with R73.03. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

   See the official tabular notes

Choose the right path

1. Is an established diagnosis that explains this sign or symptom documented?
   Yes → Review whether the documented diagnosis changes the coding pathway: a symptom integral to it is not reported separately.
   No → Continue — the sign or symptom code stands when no definitive diagnosis is established.
2. Does the documentation support a condition named in R73.03’s Excludes1 note?
   Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
   No → Continue.

   ReviewO99.81, E88.81, O24.4, R81, E16.2, E10.A

Consider R73.03. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Official instructions as workflow

• Excludes1 — check before selecting R73.03(10 notes)

  Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with R73.03: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

  CompareO99.81, E88.81, O24.4, R81, E16.2, E10.A

  See the official tabular notes · Guidelines I.A.12.a

• Excludes2 — not part of R73.03(7 notes)

  Coding workflow: The conditions named in this note are not included in R73.03. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareO28, E78, D69

  See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Borderline, diabetes mellitus
• Diabetes, diabetic (mellitus) (sugar), latent
• Prediabetes, prediabetic

Don’t confuse R73.03 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of R73.03 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• O99.81— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of abnormal glucose in pregnancy moves the case to O99.81; the two are not reported together unless documented as unrelated.

  Full comparison: R73.03 vs O99.81 →

• E08— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of diabetes mellitus moves the case to E08; the two are not reported together unless documented as unrelated.

  Full comparison: R73.03 vs E08 →

• E13— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of diabetes mellitus moves the case to E13; the two are not reported together unless documented as unrelated.

  Full comparison: R73.03 vs E13 →

• E88.81— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of dysmetabolic syndrome X moves the case to E88.81; the two are not reported together unless documented as unrelated.

  Full comparison: R73.03 vs E88.81 →

• O24.4— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of gestational diabetes moves the case to O24.4; the two are not reported together unless documented as unrelated.

  Full comparison: R73.03 vs O24.4 →

• R81— Excludes1 conflict (Excludes1 — generally not reported together)

  Not coded here — the tabular list excludes this pair for the same encounter.

  Not reported together with this code, except where the two conditions are documented as unrelated.

  What moves you there: Documentation of glycosuria moves the case to R81; the two are not reported together unless documented as unrelated.

  Full comparison: R73.03 vs R81 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• No Medicare Code Editor or MS-DRG Definitions Manual restrictions apply to this code.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name R73.03 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 9 Excludes2 notes: R83 — Abnormal findings in cerebrospinal fluid (via R73.-), R83-R89 — Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (R83-R89) (via R73.-), R84 — Abnormal findings in specimens from respiratory organs and thorax (via R73.-), R85 — Abnormal findings in specimens from digestive organs and abdominal cavity (via R73.-), R86 — Abnormal findings in specimens from male genital organs (via R73.-), R87 — Abnormal findings in specimens from female genital organs (via R73.-), R88 — Abnormal findings in other body fluids and substances (via R73.-), R89 — Abnormal findings in specimens from other organs, systems and tissues (via R73.-), R94.7 — Abnormal results of other endocrine function studies (via R73.0.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: not on the CMS CC/MCC list — as a secondary diagnosis this code does not change MS-DRG severity for that release.

Named in the grouper logic of 2 MS-DRGs: DRG 640 (MDC 10), DRG 641 (MDC 10).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):SYM018 — Prediabetes (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Diabetes, diabetic”, “Borderline”, “Prediabetes, prediabetic”; these codes share that main term but sit in a different category of the Tabular List.

M85.8 — Other specified disorders of bone density and structure (osteopenia), N25.1 — Nephrogenic diabetes insipidus (insipidus, nephrogenic), O24.410 — Gestational diabetes mellitus in pregnancy, diet controlled (gestational, diet controlled), O24.414 — Gestational diabetes mellitus in pregnancy, insulin controlled (gestational, insulincontrolled), O24.415 — Gestational diabetes mellitus in pregnancy, controlled by oral hypoglycemic drugs (gestational, oral drug controlled), O24.419 — Gestational diabetes mellitus in pregnancy, unspecified control (gestational), O24.420 — Gestational diabetes mellitus in childbirth, diet controlled (gestational, in childbirth, diet controlled), O24.424 — Gestational diabetes mellitus in childbirth, insulin controlled (gestational, in childbirth, insulincontrolled), O24.425 — Gestational diabetes mellitus in childbirth, controlled by oral hypoglycemic drugs (gestational, in childbirth, oral drug controlled), O24.429 — Gestational diabetes mellitus in childbirth, unspecified control (gestational, in childbirth), O24.430 — Gestational diabetes mellitus in the puerperium, diet controlled (gestational, puerperal, diet controlled), O24.434 — Gestational diabetes mellitus in the puerperium, insulin controlled (gestational, puerperal, insulincontrolled), O24.435 — Gestational diabetes mellitus in puerperium, controlled by oral hypoglycemic drugs (gestational, puerperal, oral drug controlled), O24.439 — Gestational diabetes mellitus in the puerperium, unspecified control (gestational, puerperal), O65.1 — Obstructed labor due to generally contracted pelvis (pelvis, with obstruction during labor), O99.893 — Other specified diseases and conditions complicating puerperium (complicating, puerperium), P70.0 — Syndrome of infant of mother with gestational diabetes (gestational, affecting newborn), P70.2 — Neonatal diabetes mellitus (neonatal), R03.0 — Elevated blood-pressure reading, without diagnosis of hypertension (hypertension), Z71.3 — Dietary counseling and surveillance (dietary counseling and surveillance), +243 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

HbA1c Test (Glycated Hemoglobin), Blood Glucose Test, HIV Screening Test, Thyroid Stimulating Hormone (TSH)

Contextual Map

Every relationship of R73.03 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run R73.03 with these 8 related codes in Claim Check

Hierarchy

• R00-R99 — Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99) (R00-R99)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R70-R79 — Abnormal findings on examination of blood, without diagnosis[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes2 notes (9)

• R83 — Abnormal findings in cerebrospinal fluid[Excludes2](via R73.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R83-R89 — Abnormal findings on examination of other body fluids, substances and tissues, without diagnosis (R83-R89)[Excludes2](via R73.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R84 — Abnormal findings in specimens from respiratory organs and thorax[Excludes2](via R73.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R85 — Abnormal findings in specimens from digestive organs and abdominal cavity[Excludes2](via R73.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R86 — Abnormal findings in specimens from male genital organs[Excludes2](via R73.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R87 — Abnormal findings in specimens from female genital organs[Excludes2](via R73.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R88 — Abnormal findings in other body fluids and substances[Excludes2](via R73.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• R89 — Abnormal findings in specimens from other organs, systems and tissues[Excludes2](via R73.-): “abnormal findings on examination of blood, without diagnosis (R70-R79)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• and 1 more

Clinical classification (CCSR)

• SYM018 — Prediabetes[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

MS-DRG Grouper

• DRG 640 — MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC[MS-DRG]: “MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC (MDC 10)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 641 — MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC[MS-DRG]: “MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC (MDC 10)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 10 — Endocrine, Nutritional and Metabolic Diseases and Disorders[MDC crossing]: “Endocrine, Nutritional and Metabolic Diseases and Disorders — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,008 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Borderline, diabetes mellitus[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Diabetes, diabetic (mellitus) (sugar), latent[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Prediabetes, prediabetic[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes

• R73 — Elevated blood glucose level[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R73.0 — Abnormal glucose[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R73.01 — Impaired fasting glucose[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R73.02 — Impaired glucose tolerance (oral)[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R73.09 — Other abnormal glucose[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• R73.9 — Hyperglycemia, unspecified[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Change history

• FY2017 — Added to the code set[Change history]— CMS release files (code change ledger) · icd10cm-fy2017

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to R73.03 in its code family, with their registry titles.

• R73 — Elevated blood glucose level
• R73.0 — Abnormal glucose
• R73.01 — Impaired fasting glucose
• R73.02 — Impaired glucose tolerance (oral)
• R73.09 — Other abnormal glucose
• R73.9 — Hyperglycemia, unspecified

View all codes in the R73 family