In case you missed the Harmony Healthcare sponsored webinar on the FY2025 ICD-10-CM/PCS updates, this article will summarize some of the salient points for you. You can also view the webinar recording.
ICD-10-CM Updates and Changes for 2025
Let’s start out with coverage of the guideline changes. For ICD-10-CM, the biggest change was the introduction of new guideline I.C.4.a.1.a which addresses presymptomatic type 1 diabetes mellitus. Coding professionals are directed to use a code from E10.A- for early-stage type 1 diabetes which is before the symptoms begin. This also introduces one of the code changes for ICD-10-CM effective October 1, 2025, which are the E10.A- codes. The good news for coding professionals is that there are no ICD-10-PCS guideline changes for FY2025.
Categories C81-C88, which capture lymphoma codes, now can identify when those conditions are in remission.
Code D89.383 for cytokine release syndrome has a new “Use additional code” note directing coders to assign an additional code for an adverse effect of immune checkpoint inhibitors and immunostimulant drugs if appropriate. This update included the addition of immune checkpoint inhibitors and immunostimulant drugs in the Table of Drugs and Chemicals.
Not only do you have three new codes at E10.A- for the capture of presymptomatic type 1 diabetes, but you are also able to capture hypoglycemia level at E16.A-.
Coding for obesity brings some major changes for FY2025. You can now assign the obesity code based on class (1-3). Two new body mass index (BMI) codes for pediatric patients were added as well as code E88.82 for obesity due to disruption of MC4R pathway.
Codes from the new category G40.84- can now be assigned to capture KCNQ2-related epilepsy. These codes will identify if the epilepsy is intractable or not, and with or without status epilepticus in the same way as other epilepsy codes already in existence.
Codes for eating disorders such as anorexia nervosa, binge eating, and bulimia now have additional characters to identify the severity of the condition: mild, moderate, severe, extreme, in remission, and unspecified. New codes were added for pica in adults (F50.83) and rumination disorder in adults (F50.84).
Pulmonary embolism (PE) codes expanded with the updates for 2025. Now coding professionals can code PEs that occur due to cement or fat. Cement embolisms occur following a kyphoplasty or vertebroplasty when the fast-setting cement used is introduced into the circulatory system. Fat embolisms tend to occur following long bone fractures when fat particles are introduced into the bloodstream. Both changes are reflected in PE codes for with and without acute cor pulmonale. It should be noted that these codes are also considered MCCs on an inpatient account.
Anal, rectal, and anorectal fistula codes underwent a major revision with this code update. Fifth characters are needed to identify if the fistula is simple or complex, and sixth characters indicate if the fistula is new, chronic, recurrent, or unspecified.
Codes for other intervertebral disc degeneration of the lumbar and lumbosacral regions will now require a sixth character to identify if there is also discogenic back pain, lower extremity pain, both, or without mention of either. The unspecified synovitis and tenosynovitis code M65.9 underwent expansion to identify specific sites, with an additional sixth character needed to assign laterality.
Q23.81 is now a code for a bicuspid aortic valve with Q23.82 assigned when a patient has a congenital mitral valve cleft leaflet.
Code T81.32 has been expanded to capture specific areas of disruption or dehiscence of operational wounds.
Z17 underwent a title revision and now reflects “Estrogen, and other hormones and receptor status”, with a note indicating that coding professionals should be assigning a code for each receptor unless only a combined receptor status is documented.
Z51.A is a new code for an encounter for sepsis aftercare. Also, Z59.7 was expanded to allow capture of insufficient health insurance coverage and insufficient welfare support independently.
Social determinant of health codes for inadequate housing and housing instability (Z59.1- and Z59.8-) will now be considered as CCs for an inpatient account.
ICD-10-PCS Updates and Changes for 2025
Now, let’s switch to look at the ICD-10-PCS changes for fiscal year 2025. As mentioned earlier, there are no guideline additions or revisions to ICD-10-PCS with this update. There were several body part reference updates which include the following:
- Adductor pollicis muscle=hand muscle (left or right)
- Anconeus muscle=lower arm and wrist muscle (left or right)
- Iliopsoas muscle=hip muscle (left or right)
- Plantaris muscle=lower leg muscle (left or right)
- Hamstring muscle=upper leg muscle (left or right)
- Prevesical space=pelvic cavity
The root operation “Division” was added to the New Technology section of ICD-10-PCS.
The addition of the facet joint fusion device, paired titanium cages required a change in the Alphabetic Index as the option for fusion also includes Interbody fusion device, custom-made anatomically designed.
The coding for BlackArmor® Carbon/PEEK fixation system or VADER® Pedicle System now directs coding professionals to Carbon/PEEK Spinal Stabilization Device, Pedicle Based. This is different than coding for a posterior spinal motion preservation device.
ICD-10-PCS codes are now available for capturing gyroid sheet lattice design internal fixation devices for the ankle or tarsal. Note, this is a different device than an internal fixation device that is for an open-truss design.
The GORE ® EXCLUDER ® TAMBE Device (Thoracoabdominal Branch Endoprosthesis) device is a single endograft used in the treatment of a thoracoabdominal aortic aneurysm. Branched Intraluminal Device, Manufactured Integrated System, Four or More Arteries is the correct device character that should be assigned.
An entirely new table was added in the lymphatic system, table 071, which allows coding of a bypass procedure normally used in treatment of or prophylaxis for lymphedema.
A new qualifier, B, was added to the breast replacement table at 0HR for reconstruction with a lumbar artery perforator flap.
A code, 5A05A0L, has been added for an intraoperative filtration, veno-venous bypass, performed during a percutaneous thrombectomy. Coding professionals should note that two codes are necessary to completely code for these procedures: one for the percutaneous thrombectomy and one for the filtration.
Moving onto New Technology codes, last year we saw a new ICD-10-PCS code for ultrasound ablation of the renal arteries. This year, a new code has been added for radiofrequency ablation of the renal arteries at X05133A.
A second filtration was also added this year, this time for filtration of blood at the microscopic level to remove viruses or bacteria. That new code is XXA536A.
Next is a new code to capture valve-leaflet splitting. This is a procedure that is done when a patient is undergoing a valve-in-valve transcatheter aortic valve replacement (TAVR). When a valve-valve TAVR is done, there is the potential for displacement of the initial valve’s leaflets which could result in a life-threatening coronary blood flow. X28F3VA is the code for the valve splitting. This is where the addition of the root operation Division comes into play in New Technology. Be aware that once again two codes will be needed to capture the full extent of the procedure, both the leaflet splitting and the insertion of the new valve.
Finally, there is a new code for a drug coated balloon used to treat in-stent restenosis. The drug is Paclitaxel and the device qualifier will depend on the number of balloons deployed (1-4). Coding professionals will also need to code any angioplasty done to prepare the vessel, and/or any stents that are deployed after the balloon(s) are introduced.
The codes identified above are just some of the FY2025 codes for ICD-10-CM/PCS.
Wrapping up, remember to always look at guideline updates and note changes as well as new codes when updates are released to ensure you are getting as much relevant information as you can.
Hope to have you join me for the next Harmony Healthcare webinar on Thursday, December 12th at 3:00 p.m. EST where I’ll share the 2025 CPT code updates and you can earn free CEUs. Until then, happy coding!
This article was authored by Dianna Foley, RHIA, CCS, CDIP, CHPS, External Education Partner/Consultant
