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.
Examples:
- 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.