On July 3, 2024, the Centers for Medicare & Medicaid Services
(CMS) released the FY 2025 International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code updates. The FY 2025 ICD-10-CM updates introduce over 300 code changes, including 252 new codes, 13 deletions, and 36 revisions, reflecting ongoing advancements in clinical documentation and disease specificity. These code changes will go into effect with October 1, 2024, discharges.
Here are 11 key takeaways and insights from the FY 2025 ICD-10-CM Code updates
- Lymphoma in Remission: The introduction of sixty-three new ICD-10-CM diagnosis codes allow for the precise identification of lymphoma, in both active and remission stages. These codes were expanded with a fifth character to indicate if the lymphoma is “in remission.” The new diagnosis codes will allow for meaningful comparison to assess statistical data, patient care, clinical outcomes, and resource consumption.
- Diabetes Updates: Three new ICD-10-CM diagnosis codes for presymptomatic Type 1 Diabetes (E10.A-) were added to capture early-stage diagnosis, highlighting the importance of recognizing diabetes before symptoms appear.
- Personal History of Polyps: Four new codes were added to expand the ICD-10-CM code set for personal history of polyps. Colon polyps can be grouped as non-neoplastic and neoplastic. Nonneoplastic polyps characteristically do not become cancerous and include hamartomatous, inflammatory, and hyperplastic polyps. Neoplastic polyps have the possibility to develop cancer with enough time to grow. Examples of neoplastic polyps include adenomas and serrated types. New codes will provide coding specificity for personal history of polyps to identify individuals with risk factors.
- Fanconi Anemia: A rare genetic disorder, Fanconi anemia, now has its own ICD-10-CM diagnosis code (D61.03), enabling better tracking of this condition, which affects bone marrow and increases malignancy risk. This condition is classified as a complication and comorbidity (CC) for FY 2025.
- Obesity Classifications: Four new ICD-10-CM diagnosis codes (E66.811-E66.89) specify various classes of obesity, which will allow for better management and tracking of obesity’s impact on health. Obesity in adults is subdivided into the following: Class 1: BMI of 30 to < 35; Class 2: BMI of 35 to < 40; Class 3: BMI of 40 or higher (sometimes categorized as “severe” obesity).
- Eating Disorders: Enhanced specificity in eating disorder ICD-10-CM diagnosis codes (F50.010-F50.029) now differentiates between restricting and binge-purge types of anorexia, providing greater clarity for clinicians. Also, codes will specify if mild, moderate, severe, or extreme anorexia. Mild: BMI greater than or equal to 17kg/m; Moderate: BMI 16-16.99kg/m; Severe: BMI 15-15.99 kg/m; Extreme: BMI less than 15 kg/m.
- KCNQ2-Related Epilepsy: Four new codes (G40.43X-) for KCNQ2-related epilepsy allow clinicians to document and treat this genetic childhood epilepsy with more precision, improving patient outcomes. KCNQ2-related epilepsy is one of the most common genetic epilepsy syndromes in childhood. KCNQ2 is not the name of a medical condition but is the name of the gene that is affected.
- Pulmonary Embolism Expansion: Four new codes for fat and cement pulmonary embolism (I26.03-I26.04 and I26.95-I26.96) facilitate better distinction and treatment. A fat pulmonary embolism is when one or more droplet-like particles of fat enter the bloodstream and embolize through the systemic or pulmonary circulation. Fat emboli are seen in individuals or patients who have complex fractures; burns; liposuction, lipo-injection, fat grafting, panniculitis, orthopedic surgeries, and cardiopulmonary resuscitation. Cement pulmonary embolism is a complication that can occur when polymethyl methacrylate (PMMA), a type of acrylic cement, leaks into the pulmonary arteries during procedures like vertebroplasty or kyphoplasty. PMMA is often used in these minimally invasive procedures to treat vertebral fractures or with knee and hip arthroplasty procedures. The cement can leak into the veins and then into the pulmonary arteries.
- Nasal Valve Collapse (NVC): Seven new codes for nasal valve collapse (J34.82-) to differentiate between internal of external nasal valve collapse and if the collapse is static or dynamic. NVC is defined as a weakness or narrowing of the internal or external nasal valves. Symptoms associated with NVC, either static or dynamic, may include difficulty in nasal inspiration, exercise intolerance, sleep disturbance and decreased quality of life.
- Congenital Heart Conditions: New codes for bicuspid aortic valve (Q23.81) and other congenital heart malformations (Q23.82 and Q23.88) help clinicians track these conditions' progression and potential complications. Bicuspid aortic valve is the most common congenital heart defect. Bicuspid aortic valve is the presence of only two valve cusps rather than the normal three. For new code Q23.81, there is a tabular note to code also, if applicable, acquired aortic valve disorders, such as: aortic insufficiency (I35.1), aortic stenosis (I35.0), and aortic stenosis with insufficiency (I35.2).
- Immune Checkpoint Inhibitors: Eighteen new codes were created to track poisoning, adverse effects, and underdoing of immune checkpoint inhibitors, an expanding cancer therapy that can have severe side effects across multiple organ systems. Some of the common immune checkpoint inhibitors include Pembrolizumab (Keytruda), nivolumab (OPDIVO), avelumab (Bavencio), durvalumab (Imfinzi), and Ipilimumab (Yervoy).
These updates reflect the continuous evolution of medical coding to match advancements in medical practice, patient care, and research. As medical coding professionals, it is our responsibility to keep up to date with the annual code changes and understand how to apply them correctly with October 1, 2024, discharges/dates of service. Download our eBook, FY 2025 ICD-10-CM Code Updates, and attend our webinar, Mastering the FY 2025 ICD-10-CM Code and Guideline Updates,” for the latest information.
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