Prediabetes

This diagnosis code signifies a state of elevated blood glucose levels that are higher than normal but not yet meeting the diagnostic criteria for type 2 diabetes mellitus. It indicates impaired glucose tolerance or impaired fasting glucose, placing the individual at increased risk for developing full-blown diabetes.

Use this code when documentation indicates a patient has blood glucose levels consistent with prediabetes, such as an HbA1c between 5.7% and 6.4%, fasting plasma glucose between 100 mg/dL and 125 mg/dL, or a 2-hour post-glucose load plasma glucose between 140 mg/dL and 199 mg/dL. This code is appropriate for screening, monitoring, and managing patients identified with this condition.

• Do not code this if the patient has a definitive diagnosis of type 1 or type 2 diabetes; those conditions take precedence.
• Always ensure the medical record clearly states the diagnostic criteria met (e.g., specific lab values) to support this diagnosis.
• Consider sequencing this code as a primary diagnosis when prediabetes is the main reason for the encounter, or as a secondary diagnosis when managing other conditions in a patient with prediabetes.