Once again, on April 1, 2025, the ICD-10 classifications of CM and PCS have undergone a fresh update. While this isn’t the biggest update ever seen, there are still significant changes for coding professionals.
Here we’ll share some of the key points.
Important ICD-10-CM Updates
There are no actual code changes to the ICD-10-CM code in the April, 2025 update. However, there are two important guideline changes:
1. Guideline I.C.1.g.1.h:
(h) Asymptomatic individuals who test positive for COVID-19
For asymptomatic individuals who test positive for COVID-19 and there is no provider documentation of a diagnosis of COVID-19, query the provider as to whether or not the individual has COVID-19. A false positive laboratory test is possible, and it is the provider’s responsibility to confirm the diagnosis and document accordingly.
Requiring clarification by the provider for asymptomatic individuals who test positive for COVID-19 is the focus of this change. Previously, coding professionals were instructed to code the COVID-19 for asymptomatic patients with a positive COVID-19 test. This presents an opportunity for CDI specialists to educate providers and avoid lengthy coding delays when there is no clarity in the medical record.
2. New guideline at Guideline I.C.4.b.:
b. Obesity
The obesity codes in category E66, Overweight and obesity, include codes related to the cause of obesity, such as drug-induced obesity (E66.1), and codes related to effects of obesity, such as code E66.2, Morbid (severe) obesity with alveolar hypoventilation. There are other codes related to obesity in other categories of the classification, such as E88.82, Obesity due to disruption of MC4R pathway; and codes in fifth character subcategory O99.21, Obesity complicating pregnancy, childbirth, and the puerperium.
1) Obesity class
The obesity class codes in subcategory E66.81, Obesity class, require a fifth character to convey the severity of obesity. The obesity class should be documented in the medical record by the provider for these codes to be assigned. The obesity class codes can be reported with other obesity codes in the classification found in Chapters 4 and 15 to fully describe the condition. However, if both class 3 obesity and morbid obesity are documented, only a code for class 3 obesity should be assigned as it is more specific.
The key takeaway here is that the obesity class cannot be determined by body mass index (BMI) alone. The provider must determine the class. This is evidenced when reviewing both the Alphabetic Index and Tabular List. Neither list BMI as associated with the obesity class designations. There was a Fourth Quarter Coding Clinic addressing this new guideline in which there was a designation of BMI to a specific class, but the advice reiterated that it is the provider who is responsible for the obesity class assignment.
The remainder of the ICD-10-CM changes were either correcting spelling errors or implementing some note changes. A few of the keynote changes address the use of an additional code for cachexia with tuberculosis, hypopituitarism, or pneumoconiosis associated with tuberculosis when applicable. Again, an additional code for ascites is now found for both hepatic failure and chronic hepatitis not elsewhere classified when applicable. Also, at category S06 for intracranial injury, designation of an appropriate 7th character is covered with the change addressing exceptions noted.
Important ICD-10-PCS Updates
The ICD-10-PCS classification has no guideline changes in the April, 2025 update. There are some definition updates which include:
- Using thoracic Aorta, Ascending/Arch when coding for the body part aortic root
- Using synthetic substitute as the device character for several GORE products including a septal occlude and TIPS endoprosthesis
- Using conduit through coronary sinus to right atrium for the APTURE transcatheter shunt system
ICD-10-PCS code updates involve:
- New approach character 8 (via natural or artificial opening endoscopic) as an option for a tracheoesophageal puncture
- Ability to code for a laryngeal transplant
- Codes for kidney transplantectomy
- Options are left or right kidney unless centrally located-then correct laterality is determined by where the vascular anastomosis is
- Transjugular Intrahepatic Postosystemic shunt (TIPS) procedure in the Index will redirect coding professionals to table 061 for Bypass, lower veins
- New qualifier added to facilitate coding for an ileal vaginoplasty
- Option to use Open as the approach for retained products of conception removal
In New Technology, we see the new code X2U93YA for the valve(s) when coding a TricValve transcatheter bicaval valve system. This code should be assigned in addition to the codes for the insertion of the valve(s). Essentially, three codes are then needed when coding this procedure, realizing that the insertion is for each body part (superior and inferior vena cava).
There are also new codes in New Technology for an automated strut adjustment external fixation ring device. This device is utilized when treating long bone fractures, allowing for smaller, more frequent adjustments minimizing soft tissue issues. Be sure to code any other procedures that may take place at the same time such as osteotomies or repositioning.
There were also twelve ICD-10-PCS codes that were deleted in this update. These all relate to coding coccyx fusion. The coccyx is composed of 3-5 bones which become fused over an individual’s 20s or 30s. This means that it is not clinically valid to have codes that would address coccyx fusion as that structure is already fused. Generally, when treatment of the coccyx is needed for a condition such as coccydynia, a partial or total coccygectomy would be performed. Therefore, in table 0SG for lower joint fusion, the coccygeal joint part 6 was removed along with 3 approach options and 4 device characters accounting for the 12 codes that were deleted.
These are some of the ICD-10-CM/PCS changes coding professionals can expect to see from the April, 2025 update Keep an eye out for the next Harmony Healthcare coding presentation. Until then, happy coding!
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This article was authored by Dianna Foley, RHIA, CCS, CDIP, CHPS, External Education Partner/Consultant
