Recent code set updates allow healthcare providers to be more specific regarding patients’ problems.
The latest update regarding ICD-10-CM is out. People in the healthcare industry are anxious to know what changes and implications it holds for their coding practices and compliance. The Centers for Medicare & Medicaid Services (CMS) announced the update for FY2025, later than usual, on the 3rd of July, to be effective from the 1st of October 2024 till September 30, 2025.
The recent update includes:
- 252 new codes
- 36 code deletions
- 13 code revisions
The addition of 252 new codes is done to identify new conditions. This helps to specify prevailing conditions clearly and in creating new code categories. 36 deletions have been done to simplify expansion in related categories. Lastly, 13 revisions are made to implement technical corrections or to enhance clarity.
The updated version of the code set offers more detail and precision. This expansion will improve tracking, reporting, and billing for specific conditions, treatments, and procedures. However, compared to last year, the total number of codes released this year was less, i.e., FY 2024 saw 395 new ICD-10 codes, 25 deletions, and 22 revisions.
Also, many codes have been converted to non-billable parent codes, making way for more specific child codes, including fifth, sixth, and seventh characters to indicate the location and status of the condition.
ICD-10-CM
Before discussing the code updates in detail, let’s give you a brief overview of ICD-10-CM, what it is, and why it is critical to healthcare professionals in the US.
What is ICD-10-CM?
It is a systematic classification of diagnostic codes followed strictly by the healthcare industry across the US. Used to classify and code different diseases and conditions, the right usage of these codes allows for accurate billing, medical health reporting, and research.
Simply put, healthcare professionals use these alphanumeric codes to document patient diagnoses. The correct usage of these codes affects insurance claims, reimbursements, and statistical data. Owing to ICD-10-CM’s significance in the healthcare industry, it undergoes periodic updates to align with the latest clinical practices.
What’s new in ICD-10-CM for FY 2025?
Updated annually on the Centers for Medicare and Medicaid Services (CMS) website, the code set sees many significant changes yearly. It is important for healthcare professionals to get acquainted with these updates to ensure error-free claim submissions.
Chapter Specific Changes
Most diagnosis codes effective from the 1st of October 2024 are chapter-specific. In the next section, we’ve mentioned a chapter-by-chapter breakdown of ICD-10 code changes for the following year.
Chapter 1: Certain Infectious and Parasitic Diseases
Code Range: A00-B99
No new codes and code changes for the chapter related to infectious and parasitic diseases exist. However, there’s a small revision in A77.41 to correct the spelling of ‘chaffeensis.’
Chapter 2: Neoplasm and Anemia
Code Range: C00-D49
The chapter takes the lead with 64 changes. Here, we see many codes expanded and converted to parent codes. The addition of character ‘A’ indicated cancer ‘in remission.’ For example, seven new codes under Hodgkin Lymphoma describe many types of it while in remission. Such as C81.3A (Lymphocyte depleted Hodgkin lymphoma, in remission)
| C81.1A | Nodular sclerosis Hodgkin lymphoma, in remission |
| C81.2A | Mixed cellularity Hodgkin lymphoma, in remission |
| C81.3A | Lymphocyte-depleted Hodgkin lymphoma, in remission |
| C82.5A | Diffuse follicle center lymphoma, in remission |
| C82.6A | Cutaneous follicle center lymphoma, in remission |
Chapter 3: Diseases of the blood and blood-forming organs
Code Range: D50-D89
Includes only one new code for Fanconi anemia (D61.03).
| D61.03 | Fanconi anemia |
Chapter 4: Endocrine, nutritional, and metabolic diseases
Code Range: E00-E89
This chapter includes 16 code updates with the addition of levels and classes to hypoglycemia and obesity. Here, we see new codes for presymptomatic Type 1 diabetes mellitus, Hypoglycemia levels, carcinoid syndrome, obesity class, citrate metabolism disorders and Obesity due to disruption of MC4R pathway get new codes.
| E16.A2 | Hypoglycemia level 2 |
| E16.A3 | Hypoglycemia level 3 |
| E66.81 | Obesity class |
| E66.811 | Obesity, class 1 |
| E74.82 | Disorders of citrate metabolism |
| E74.820 | SLC13A5 Citrate Transporter Disorder |
| E74.829 | Other disorders of citrate metabolism |
Chapter 5: Mental, behavioral, and neurodevelopmental disorders
Code Range: F01-F99
A total of 26 new codes have been added in this chapter. We see new codes for anorexia nervosa restricting type, bulimia nervosa, and binge eating disorder. 2 new codes for mental and behavioral conditions added are Pica in adults and Rumination disorder in adults.
| F50.010 | Anorexia nervosa, restricting type, mild |
| F50.023 | Anorexia nervosa, binge eating/purging type, extreme |
| F50.21 | Bulimia nervosa, mild |
| F50.814 | Binge eating disorder, in remission |
| F50.83 | Pica in adults |
| F50.84 | Rumination disorder in adults |
Chapter 6: Diseases of the nervous system
Code Range: G00-G99
Seven changes are made under G40 Epilepsy and recurrent seizures, like the inclusion of KCNQ2-related epilepsy and multiple child codes to identify if the disease is intractable with status epilepticus. Other new codes are for serotonin syndrome, autonomic nervous system disorders, and developmental and epileptic encephalopathy, such as
| G40.841 | related epilepsy, not intractable with, with status epilepticus |
| G40.842 | related epilepsy, not intractable, without status epilepticus |
| G40.843 | related epilepsy, intractable, with status epilepticus |
| G40.844 | related epilepsy, intractable, without status epilepticus |
Chapter 7: Diseases of the Eye and Adnexa
Code Range: H00-H59
To remove the reference to bilateral ‘eye’, five fifth character codes that fall under Degenerative myopia are revised.
| H44.2A3 | Degenerative myopia with choroidal neovascularization, bilateral |
| H44.2B3 | Degenerative myopia with macular hole, bilateral |
| H44.2C3 | Degenerative myopia with retinal detachment, bilateral |
| H44.2D3 | Degenerative myopia with foveoschisis, bilateral |
| H44.2E3 | Degenerative myopia with other maculopathy, bilateral |
Chapter 8: Diseases of the Ear and Mastoid Process
Code Range: H60-H95
Diseases for the ear and mastoid process (H60-H95) see no changes.
Chapter 9: Diseases of the Circulatory System
Code Range: I00-I99
To expand the I26 Pulmonary embolism subcategory, the new update sees the addition of four new codes Two prevailing codes (I26.93-I26.94) were revised to add to the term thrombotic.
| 126.03 | Cement embolism of pulmonary artery |
| I26.04 | Fat embolism of the pulmonary artery with acute core pulmonale |
| I26.95 | cement embolism of the pulmonary artery without core pulmonale |
| I26.96 | Fat embolism of the pulmonary artery without acute core pulmonale |
Chapter 10: Diseases of the Respiratory System
Code Range: J00-J99
There are 8 changes here, including new codes for nasal valve collapse under J21 Acute bronchiolitis. The addition of the sixth and seventh characters describes the location of the collapse, i.e., internal/external, and the state of the condition, i.e., static/dynamic/unspecified, respectively.
| J34.8200 | Internal nasal valve collapse, unspecified |
| J34.8201 | Internal nasal valve collapse, static |
| J34.8202 | Internal nasal valve collapse, dynamic |
| J34.821 | External nasal valve collapse |
| J34.8210 | External nasal valve collapse, unspecified |
Chapter 11: Diseases of the Digestive System
Code Range: K00-K95
In the chapter related to diseases of the digestive system, we see the addition of 27 new codes related to Anal fistula, Rectal fistula, and Anorectal fistula , some examples are given below
| K60.311 | Anal fistula, simple, initial |
| K60.32 | Anal fistula, complex |
| K60.413 | Rectal fistula, simple, recurrent |
| K60.422 | Rectal fistula, complex, persistent |
| K60.50 | Anorectal fistula, unspecified |
| K60.519 | Anorectal fistula, simple, unspecified |
| K60.522 | Anorectal fistula, complex, persistent |
Chapter 12: Diseases of the Skin and Subcutaneous Tissue
Code Range: L00-L99
This chapter includes 8 new codes for cholestatic pruritus and other pruritus . Also, Lichen planus L43 sees six new five-character codes that completely describe lichen planopilaris to go along with centrifugal cicatricial alopecia.
| L66.10 | Lichen planopilaris, unspecified |
| L66.11 | Classic Lichen planus |
| L66.12 | Frontal fibrosing alopecia |
| L66.19 | Other lichen planopilaris |
| L66.89 | Other Cicatricial alopecia |
Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue
Code Range: M00-M99
ICD-10-CM introduces 33 new codes for musculoskeletal system and connective tissue-related diseases. Six new characters under M51 Thoracic, thoracolumbar, and lumbosacral intervertebral disk disorders let the practitioner precisely specify the exact location of pain.
We also see the addition of various fifth and sixth character codes under the subcategory M65 Synovitis and tenosynovitis. Using these codes, the practitioner can precisely document the location of the unspecified synovitis and tenosynovitis.
| M62.85 | dysfunction of multifidus muscle, lumbar region |
Added codes for specific sites.
| Shoulder | M65.91, M65.911 (Right), M65.912 (Left), M65.919 (Unspecified) |
| Upper Arm | M65.92, M65.921 (Right), M65.922 (Left), M65.929 (Unspecified) |
| Forearm | M65.93, M65.931 (Right), M65.932 (Left), M65.939 (Unspecified) |
| Hand | M65.94, M65.941 (Right), M65.942 (Left), M65.949 (Unspecified) |
| Thigh | M65.95, M65.951 (Right), M65.952 (Left), M65.959 (Unspecified) |
| Lower Leg | M65.96, M65.961 (Right), M65.962 (Left), M65.969 (Unspecified) |
| Ankle and Foot | M65.97, M65.971 (Right), M65.972 (Left), M65.979 (Unspecified) |
| Other Sites | M65.98, M65.99 (Multiple Sites) |
| Unspecified Site | M65.90 |
Chapter 14: Diseases of the Genitourinary System
Code Range: N00-N99
Apart from a slight change of adding Excludes 1 note under N39 Urinary tract infection, we don’t see any notable changes in this chapter.
Chapter 15: Pregnancy, Childbirth, and the Puerperium
Code Range: O00-O9A
A few changes to codes in subcategory 024 Diabetes mellitus in pregnancy, childbirth, and the puerperium.
Chapter 16: Certain Conditions Originating in the Perinatal Period
Code Range: P00-P96
Here again, only one Excludes1 note is added under P72 Other transitory neonatal endocrine disorders.
Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities
Code Range: Q00-Q99
Includes three new codes for congenital malformations of aortic and mitral valves. Kleefstra syndrome has also been assigned one new code.
| Q23.81 | bicuspid aortic valve |
| Q23.82 | Other specified congenital malformation syndromes affecting multiple systems |
| Q23.88 | Other specified congenital malformation syndromes, not elsewhere classified |
Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified
Code Range: R00-R99
There’s only one new code added for anosognosia in ICD-10-CM for FY 2025.
| R41.85 | Anosognosia |
Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes
Code Range: S00-T88
Injuries, poisonings and external causes chapter includes 30 new fifth and sixth character codes to specify adverse effects of immune checkpoint inhibitor immunotherapy, underdosing, circumstances of poisoning, and disruption of gastrointestinal tract anastomosis.
| T45.A | Poisoning by, adverse effect of, and under-dosing of immune checkpoint inhibitors and immunostimulant drugs |
| T45.AX1 | Poisoning by, adverse effect of, and under-dosing of immune checkpoint inhibitors and immunostimulant drugs |
| T81.320 | Disruption or dehiscence of gastrointestinal tract anastomosis, repair, or closure |
| T81.321 | Disruption or dehiscence of closure of internal operation (surgical) wound of abdominal wall muscle or fascia |
| T81.328 | Disruption or dehiscence of closure of other specified internal operation (surgical) wound muscle |
| T81.329 | Deep disruption or dehiscence of operation wound, unspecified |
Chapter 20: Codes for Special Purposes
Code Range: U00-U85
The chapter regarding external causes of morbidity remains unchanged.
Chapter 21: Factors Influencing Health Status and Contact with Health Services
Code Range: Z00-Z99
The last chapter of ICD-10 codes includes several new codes. These codes report genetic susceptibility to diseases like epilepsy, neurodevelopmental disorders and obesity Also, the revision of a descriptor for subcategory Z17 helps expand the scope of hormones and to specify receptor status.
| Z15.2 | Genetics susceptibility to obesity |
| E66.813 | Obesity, class 3 |
| Z17.2 | Progesterone receptor status |
| Z17.21 | Progesterone receptor positive status PR+ |
| Z17.22 | Progesterone receptor negative status PR- |
| Z17.3 | Human epidermal growth factor 2 receptor |
| Z17.31 | Human epidermal growth factor receptor 2 positive status HER2+ |
| Z17.32 | Human epidermal growth factor receptor 2 negative status HER2- |
| Z17.4 | Combined receptor status |
| Z51.A | Encounter for sepsis aftercare |
| Z59.71 | Insufficient health insurance coverage |
| Z68.55 | Body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age |
| Z83.72 | code for reporting a family history of familial adenomatous polyposis |
Note: The latest update regarding ICD-10-CM has several changes, i.e., revisions, deletions, included terms, and parenthetical notes. We’ve tried to cover the most critical changes in this blog.
Deleted and revised codes for FY 2025
With the recent update of ICD-10-CM, we’ll see many codes getting deleted forever. Not to worry, they will be replaced with more specific codes for detailed documentation. Also, there aren’t any major code revisions in the latest update. Most changes are minor, and healthcare professionals across the US can easily comprehend them, i.e., removing the reference to bilateral ‘eye’ for degenerative myopia.
Preparing for the FY 2025 ICD-10-CM Transition
Medical practices across the US are gearing up to embrace the ICD-10-CM changes in diagnosis codes. Are you prepared to ride along and implement these changes? The first step to effectively implementing these new codes is to prepare for the changes.
You, as a practice, must step up and ensure role-based training. Medical billers, coders, physicians, and other in-house staff must go through training to ensure no claim gets rejected due to a coding error, cash flow isn’t interrupted, and you maintain coding and billing compliance.
Lastly, it is important to communicate with your electronic health record (EHR) vendor representative regarding the recent updating of codes. Make sure they update their software by including these changes, especially in EHR templates and practice management systems (PMS).
