F60.3 — Borderline Personality Disorder

Clinical Description

F60.3 codes borderline personality disorder (BPD): a long-standing pattern of intense, shifting emotions, unstable relationships and sense of self, and impulsive, sometimes self-damaging behavior. Documentation should address the pattern across contexts rather than isolated episodes.

Key Symptoms to Document

When using F60.3, your documentation should reference these symptoms:

• Emotional intensity and rapid mood shifts, with their triggers
• Stormy, all-or-nothing relationships and how the patient responds to feared rejection
• An unstable sense of self or persistent inner emptiness
• Self-harm and suicidal thoughts or behavior, with dates and severity
• Impulsive, risky behavior, naming the specific domains (e.g., spending, substance use)

Common Interventions to Document

Evidence-based interventions typically documented with this diagnosis:

• Dialectical Behavior Therapy (DBT) — individual and skills group
• Mentalization-Based Treatment (MBT)
• Transference-Focused Psychotherapy (TFP)
• Schema-focused therapy
• Targeted pharmacotherapy for specific symptoms (mood instability, impulsivity, transient psychosis)

CPT Code Pairings

Common CPT codes used when billing with F60.3. Code descriptions below are original plain-language summaries, not official AMA CPT descriptor text — consult a current CPT codebook for authoritative definitions:

• 90791 — Intake interview and diagnostic assessment
• 90837 — Individual therapy, extended session (53+ min)
• 90853 — Therapy delivered in a group of unrelated clients (DBT skills group)
• 90834 — Individual therapy, standard session (38–52 min)
• 90839 — Urgent session with a client in acute crisis, first hour

Documentation Tips

• Describe the pattern with specific behavioral examples across relationships and settings rather than counting criteria; check the diagnosis against the DSM-5-TR.
• Note that the pattern is long-standing and not limited to episodes of mood or anxiety disorders.
• Document safety risk thoroughly: chronic vs. acute suicidality, self-harm methods, and current safety plan.
• Record the treatment modality used and rationale — evidence-based therapies (DBT, MBT) should be prioritized.
• Avoid diagnosing BPD during acute crisis or in adolescents without a clear, persistent pattern over time.

Differential Diagnosis Considerations

When documenting F60.3, consider and rule out:

• Bipolar disorder (F31.x) — mood cycling vs. affective reactivity
• Complex PTSD / PTSD (F43.10)
• Major depressive disorder with emotional lability (F32.x)
• Histrionic personality disorder (F60.4)
• Narcissistic personality disorder (F60.81)
• Substance use disorders (F1x.x)

Screening Tools

Standardized measures commonly used with this diagnosis:

• MSI-BPD (McLean Screening Instrument for BPD)
• ZAN-BPD (Zanarini Rating Scale for BPD)
• BSL-23 (Borderline Symptom List)
• PAI-BOR (Personality Assessment Inventory — Borderline Scale)
• C-SSRS (for suicide risk assessment)