October 1 is right around the corner, and with it comes many ICD-10 code updates, including new, revised, and deleted ICD-10-CM and ICD-10-PCS medical codes. This article provides an overview of the medical coding changes for fiscal year (FY) 2025 and how you can prepare.
New ICD-10-CM codes for FY 2025
In total, there are 252 new medical codes scattered throughout almost every chapter of ICD-10-CM. However, Chapter 2 (neoplasms) has the most changes with many new lymphoma codes to identify ‘in remission.’ Other interesting changes include new codes for presymptomatic type 1 diabetes mellitus (Chapter 4); new codes for anorexia, bulimia, and binge-eating disorders (Chapter 5); new codes for pediatric obesity body mass index, encounter for sepsis aftercare, personal history of colon polyps, insufficient health insurance coverage (a social determinant of health), and welfare support (also a social determinant of health) (Chapter 21); and so much more. To report these and other ICD-10-CM codes correctly, be sure to use the FY 2025 ICD-10-CM Official Guidelines for Coding and Reporting.
Revised and deleted ICD-10-CM codes for FY 2025
For FY 2025, several ICD-10-CM codes will be deleted; however, they will be replaced by new, more specific options. Revised codes changes are also relatively minor (e.g., removing the reference to bilateral ‘eye’ in codes for degenerative myopia and adding the term ‘thrombotic’ to codes for subsegmental pulmonary embolism).
Want to access all of the FY 2025 medical coding updates? Visit CMS’ FY 2025 ICD-10CM website or download the codes in the FY 2025 Inpatient Prospective Payment System (IPPS) proposed rule. Click here and then download Table 6A for new diagnosis codes, Table 6C for invalid diagnosis codes, and Table 6E for revised diagnosis codes.
ICD-10-PCS code changes for FY 2025
In total, there are 371 new ICD-10-PCS codes and 61 deleted codes. Almost all of the new codes (275) are in the medical and surgical section of ICD-10-PCS. For example, there’s a new ICD-10-PCS table for bypass of lymphatic structures as well as the ability to report lumbar artery perforator flap (for post mastectomy autologous breast reconstruction) and fiber optic 3D-guided procedures. In addition, 33 new codes represent new technology such as everolimus-eluting resorbable scaffold, intraluminal bioprosthetic valve leaf splitting technology, and more. When reporting these and other ICD-10-PCS codes, be sure to use the FY 2025 ICD-10-PCS Official Guidelines for Coding and Reporting.
How to prepare for the FY 2025 ICD-10-CM and ICD-10-PCS code changes
Not sure how to prepare for these changes? Consider the following strategies:
Dig into the medical coding changes. Depending on your organization’s specialties, service lines, and patient populations, some of the coding changes may be more relevant than others. Review all of the changes to determine which ones are most important and to ensure you don’t overlook any. Reporting invalid or unspecified codes after October 1 could cause an increase in denials. Forty-one percent of healthcare leaders say denial rates are already above 3.1%.
Provide education. Medical coders aren’t the only ones who need to know about the code changes. Be sure to inform clinical documentation improvement specialists and physicians as well. In addition, it’s not just about the coding changes. With these changes often come new documentation requirements, quality measures, prior authorizations, and more.
Ensure adequate staffing levels. Adequate revenue cycle management staff is important year-round and especially when annual coding changes take effect. These changes precede open enrollment and healthcare deductible resets, both of which can sometimes add administrative burden. If you can’t recruit and retain qualified staff, it may be time to consider an outsource partnership—particularly one that leverages a global workforce and can offer additional benefits such as cost savings, streamlined efficiency, improved compliance, and enhanced cybersecurity. Outsourcing is the top strategy to address healthcare staffing shortages.
Prepare for audits. After go-live on October 1, plan to audit claims and identify any payment problems as quickly as possible.
Conclusion
Conclusion
Taking the time to review the FY 2025 ICD-10-CM and ICD-10-PCS changes helps healthcare organizations reduce inpatient coding errors, mitigate denials, and promote revenue integrity. The ICD-10 code updates also provides countless opportunities to collect more detailed information and leverage data analytics in novel ways to improve patient care.