R73.03: Prediabetes

The ICD-10-CM code for prediabetes when the provider states that diagnosis in the note and no diabetes mellitus has been established.

Billable

FY2027

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At a glance

Code Family

R73.0: Abnormal glucose

Condition

Prediabetes

HCC Mapping (v28)

None, R73.03 maps to no HCC category and carries no risk adjustment weight.

Billable

Yes, valid for HIPAA covered transactions.

Effective Date

Valid in the FY2026 code set and unchanged in the FY2027 update.

Family Specificity

R73.0 splits on which glucose abnormality the provider names. R73.03 is the code for a documented prediabetes diagnosis rather than for a laboratory value alone.

Which R73.0 code do I assign?

The R73.0 subcategory splits on which glucose abnormality the provider names in the note. R73.03 belongs only where the documentation states prediabetes as the clinical diagnosis.

When documentation says…

Code

Prediabetes

R73.03

Prediabetes. The clinician must apply the prediabetes label in the documentation. A laboratory result alone does not support this code.

Impaired fasting glucose

R73.01

Impaired fasting glucose. Use this code when the note records the fasting glucose finding without applying the prediabetes label.

Impaired glucose tolerance on oral testing

R73.02

Impaired glucose tolerance (oral). Use this code when the note records the oral glucose tolerance finding without applying the prediabetes label.

Abnormal glucose with no further detail

R73.09

Other abnormal glucose. Correct when the result is documented as abnormal and fits none of the R73.01–R73.03 descriptions.

Elevated glucose, no classification stated

R73.9

Hyperglycemia, unspecified. Reserved for elevated glucose the provider has not classified. It is not correct for a documented prediabetes diagnosis.

Type 2 diabetes mellitus

E11.9

Type 2 diabetes mellitus without complications. Once the provider establishes diabetes mellitus, a code from E08–E13 applies. The Excludes1 notes at R73 and R73.0 bar reporting R73.03 alongside it for the same condition.

Abnormal glucose in a pregnant patient

O99.81-

Abnormal glucose complicating pregnancy, childbirth and the puerperium. The obstetric chapter governs glucose findings during pregnancy. The R73.0 Excludes1 note names abnormal glucose in pregnancy (O99.81-) and gestational diabetes (the O24.4 codes).

Tabular notes

EXCLUDES1

R73.03 carries no Excludes1 note of its own. Category R73 carries an Excludes1 note for diabetes mellitus (E08–E13), diabetes mellitus in pregnancy, childbirth and the puerperium (O24.-), neonatal disorders (P70.0–P70.2) and postsurgical hypoinsulinemia (E89.1). Subcategory R73.0 carries an Excludes1 note for abnormal glucose in pregnancy (O99.81-), diabetes mellitus (E08–E13), dysmetabolic syndrome X (E88.81-), gestational diabetes (O24.4-), hypoglycemia (E16.2), type 1 diabetes mellitus, presymptomatic (E10.A-) and glycosuria (R81). Both notes govern R73.03. When any of these is documented, assign the applicable code in place of R73.03 for the same condition.

FY2027: EFFECTIVE 1 OCTOBER 2026

The FY2027 codes addenda make no addition, deletion or revision in category R73. The FY2027 tabular addenda change no instructional note in it. R73.03 is in the FY2027 billable code list and is unchanged in the FY2027 update. One nearby note did change: at category R79, hyperglycemia NOS (R73.9) moved from the Excludes1 note to the Excludes2 note. R73.03 carries no Use Additional, Code Also or Code First instruction in FY2027. No companion code is required by tabular convention.

Operational & financial impact

Why specificity matters beyond the chart: risk adjustment, DRG assignment and denial exposure all follow from which code is selected.

CMS-HCC v28 (PY2024+)

R73.03 maps to no HCC category under CMS-HCC v28.

The code contributes no weight to a Medicare Advantage risk score.

Prediabetes documentation alone does not affect risk adjustment payment.

V24 TO V28 TRANSITION

R73.03 carried no HCC mapping under CMS-HCC v24.

Version 28 did not change that status. The code remains outside the risk adjustment model.

WHERE SPECIFICITY IS LOST

R73.03 records a glucose finding, not an established disease.

When the provider documents a transition to diabetes mellitus, the encounter moves to a code from E08–E13. Codes in categories E08, E10, E11 and E13 carry HCC weight through the v28 diabetes categories. The exceptions are the newer codes E10.A0–E10.A2 and E11.A, which postdate the v28 mapping file and have no confirmed v28 status. The E09 drug or chemical induced diabetes codes are absent from the v28 crosswalk.

Review each encounter for a provider statement of diabetes mellitus before settling on R73.03.

A laboratory value that points to diabetes mellitus without a corresponding provider diagnosis warrants a query rather than a coder judgment.

MS-DRG v44 (FY2027)

As a principal diagnosis, R73.03 groups to MS-DRG 640 or 641 in MDC 10, Endocrine, Nutritional and Metabolic Diseases and Disorders, under the FY2027 MS-DRG v44 grouper.

MS-DRG 640 is Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes with MCC. MS-DRG 641 is Miscellaneous Disorders of Nutrition, Metabolism, Fluids and Electrolytes without MCC. An MCC reported as a secondary diagnosis moves the case from MS-DRG 641 to MS-DRG 640.

When another condition occasions the admission, R73.03 is reported as a secondary diagnosis alongside it.

Medicare and commercial payers

R73.03 is valid for Medicare claims.

The Medicare Diabetes Prevention Program covers beneficiaries with prediabetes. Documentation of R73.03 or of the underlying glucose findings supports eligibility for that benefit.

Program eligibility thresholds must be documented as met.

Documentation checklist to support R73.03

Chart elements that support code selection and reduce specificity-driven denials.

The term prediabetes stated by the provider as a clinical diagnosis or conclusion, in the note rather than only on a laboratory report.

The clinical basis for that conclusion, such as an HbA1c of 5.7 to 6.4 percent, a fasting glucose of 100 to 125 mg/dL, or a 2 hour oral glucose tolerance result of 140 to 199 mg/dL.

A record that documents no established diabetes mellitus, because any diagnosis from E08–E13 replaces this code.

The specific glucose finding where the provider has not applied the prediabetes label, which directs the encounter to the R73.01 or R73.02 codes.

Body mass index, where obesity or overweight is documented as a risk factor for progression to diabetes mellitus.

Tobacco use or tobacco dependence, where documented as a risk factor.

Family history of diabetes mellitus, where documented as clinically relevant.

For a pregnant patient, confirmation that the glucose finding is not one the obstetric chapter governs.

For an inpatient encounter, the condition chiefly responsible for the admission, which is sequenced as the principal diagnosis under Section II of the Official Guidelines.

FAQ

Is R73.03 a billable code?

Yes. R73.03 is a valid billable code for HIPAA covered transactions. It is valid in the FY2026 code set and unchanged in the FY2027 update.

Can R73.03 and a type 2 diabetes code be reported together?

R73.03 and a type 2 diabetes code are not reported together for the same condition. Category R73 and subcategory R73.0 each carry an Excludes1 note for diabetes mellitus (E08–E13). Once the provider establishes diabetes mellitus, the E code applies and R73.03 is no longer appropriate for that condition. Never report R73.03 and E11.9 for the same condition in the same patient.

What is the difference between R73.03 and R73.01 or R73.02?

R73.03 applies when the provider documents prediabetes as the diagnosis. R73.01 applies to a documented impaired fasting glucose finding. R73.02 applies to a documented impaired glucose tolerance finding on oral testing. The label the clinician uses in the note governs the selection.

Does R73.03 map to an HCC in 2026?

No. R73.03 maps to no HCC category under CMS-HCC v28. It carried no HCC category under v24 either. Prediabetes documentation alone does not affect a Medicare Advantage risk score. Confirmed diabetes coded to E08, E10, E11 or E13 carries HCC weight in v28. The exceptions are the newer codes E10.A0–E10.A2 and E11.A, which postdate the v28 mapping file and have no confirmed v28 status. The E09 drug or chemical induced diabetes codes are absent from the v28 crosswalk.

Is an HbA1c of 6.0 percent enough to assign R73.03?

An HbA1c of 6.0 percent supports R73.03 only when the provider has documented prediabetes as a clinical conclusion in the note. The laboratory result alone does not determine code selection. The clinician's documented diagnosis governs.

What changes when a patient progresses from prediabetes to type 2 diabetes?

The encounter moves to E11.9, or to the E11 combination code that matches the complications documented. R73.03 is no longer reported for that condition. E11.9 maps to HCC 38, Diabetes with Glycemic, Unspecified, or No Complications, under CMS-HCC v28, which R73.03 does not.

How does R73.03 differ between outpatient and inpatient coding?

In the outpatient setting R73.03 is reported for ongoing prediabetes monitoring when the provider documents prediabetes. Code the documented condition. Do not report the underlying laboratory findings separately. On the inpatient side, when another condition occasions the admission, prediabetes is reported as a secondary diagnosis alongside it.

What changed for R73.03 in FY2027?

R73.03 is unchanged in the FY2027 update, effective 1 October 2026. The FY2027 addenda make no change in category R73. At category R79, hyperglycemia NOS (R73.9) moved from the Excludes1 note to the Excludes2 note.

Related codes

Codes in the same family as R73.03. Only codes with a published page render as links.

Sibling codes in the R73.0 family

R73.01: Impaired fasting glucose.
R73.02: Impaired glucose tolerance (oral).
R73.09: Other abnormal glucose.

Additional codes to consider

Codes outside the R73.0 family considered alongside R73.03.

Consider instead

E11.9: Type 2 diabetes mellitus without complications. Use once the provider establishes type 2 diabetes.
E10.9: Type 1 diabetes mellitus without complications. Use once the provider establishes type 1 diabetes.
E08.9: Diabetes mellitus due to underlying condition without complications. Use when the diabetes is attributed to an underlying condition.
E09.9: Drug or chemical induced diabetes mellitus without complications. Use when a drug or chemical is documented as the cause.
E13.9: Other specified diabetes mellitus without complications. Use for a specified type that fits none of the other diabetes categories.
R73.9: Hyperglycemia, unspecified. Use for elevated glucose the provider has not classified.
E88.81-: Metabolic syndrome and other insulin resistance. Use when dysmetabolic syndrome X is documented.
R81: Glycosuria. Use for glucose in the urine, which is a distinct finding from elevated plasma glucose.
E16.2: Hypoglycemia, unspecified. Use for low blood glucose.
E10.A-: Type 1 diabetes mellitus, presymptomatic. Use when presymptomatic stage 1 or stage 2 type 1 diabetes is documented.
O99.81-: Abnormal glucose complicating pregnancy, childbirth and the puerperium. Use for a glucose finding during pregnancy.
O24.4-: Gestational diabetes mellitus. Use when gestational diabetes is documented.

Sources

All claims on this page derive from government and professional-standards sources.

National Center for Health Statistics. (2026). International classification of diseases, tenth revision, clinical modification (ICD-10-CM) FY2027 files. https://www.cdc.gov/nchs/icd/icd-10-cm/files.html
Centers for Medicare & Medicaid Services and National Center for Health Statistics. (2026). ICD-10-CM official guidelines for coding and reporting FY2027. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2027/ICD-10-CM-October-1-2026-FY27-Guidelines.pdf
Centers for Medicare & Medicaid Services. (2025). 2026 model software/ICD-10 mappings. https://www.cms.gov/medicare/payment/medicare-advantage-rates-statistics/risk-adjustment/2026-model-software-icd-10-mappings
Centers for Medicare & Medicaid Services. (2026). MS-DRG classifications and software, version 44. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/ms-drg-classifications-and-software