F60.3 — Borderline Personality Disorder

Clinical Description

F60.3 codes borderline personality disorder (BPD), characterized by a pervasive pattern of instability in interpersonal relationships, self-image, and affect, with marked impulsivity beginning by early adulthood. 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:

• Frantic efforts to avoid real or imagined abandonment
• Pattern of unstable and intense interpersonal relationships (idealization/devaluation)
• Identity disturbance with markedly unstable self-image or sense of self
• Impulsivity in at least two domains (spending, substance use, binge eating, reckless driving)
• Recurrent suicidal behavior, gestures, threats, or self-harm
• Affective instability with marked reactivity of mood

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:

• 90791 — Psychiatric diagnostic evaluation
• 90837 — Individual psychotherapy, 60 minutes
• 90853 — Group psychotherapy (DBT skills group)
• 90834 — Individual psychotherapy, 45 minutes
• 90839 — Crisis psychotherapy, first 60 minutes

Documentation Tips

• Document at least 5 of 9 DSM-5 criteria with specific behavioral examples demonstrating a pervasive pattern.
• Note that the pattern is enduring (present since early adulthood) 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)