Borderline Diagnoses

When a provider writes that a diagnosis is borderline, many coders will query the physician before coding.  However, the ICD-10-CM Official Guidelines for Coding and Reporting states that borderline diagnoses are not considered uncertain and that there is no distinction between a borderline dx in an inpatient setting vs. an outpatient one.  This means that, unless the borderline diagnosis has its own code, you can code a borderline dx as the dx without querying the provider.


  • Borderline diabetes is coded as pre-diabetes R73.03.
  • F21 is used for borderline or latent schizophrenia.

Of course, if you’re unsure, always make the query and await a response before coding.

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