ICD-10-CM: What’s New for 2025

How are we preparing for the end of year already? Didn’t 2024 just begin? Unfortunately, we are heading into fall season and that starts with updates to the ICD-10-CM codes. These changes go into place on October 1, 2024. There is no grace period. The time to prepare for these changes is before they go into effect. ICD-10-CM codes are date-specific. Claims prior to date of service October 1, 2024 need to use the codes for that time period.

While ICD-10-CM codes are updated semi-annually, the major updates occur in October. Changes are down from last year with 252 new codes, 36 code deletions, and 13 code revisions. There are several things to review when an update come out.

1. Guidelines: Have the rules changed? The official ICD-10 guidelines for fiscal year 2025 are found at https://www.cms.gov/files/document/fy-2025-icd-10-cm-coding-guidelines.pdf. Scroll through the guidelines: narrative changes appear in bold text, items underlined have been moved since the prior version, and italics are used to indicate revisions to headings.
2. Revisions: Does the code mean the same thing as it did last year? Revisions are important because they involve a change in description versus a change in code number.
3. Deleted Codes: Do I need to document with more detail? Deletions are usually done in combination with the creation of new codes when digits are added to an existing code to be even more specific.
4. New Codes: Should I be using a completely different code now? Sometimes, instead of the addition of digits, a brand new category may be created in a completely different section of the ICD-10-CM code set.

Let’s review some of the changes that may be pertinent to urgent care.

New codes were added for presymptomatic diabetes for early-stage type 1 diabetes that predates the onset of symptoms.

• E10.A0 Type 1 diabetes mellitus, presymptomatic, unspecified
• E10.A1 Type 1 diabetes mellitus, presymptomatic, Stage 1
• E10.A2 Type 1 diabetes mellitus, presymptomatic, Stage 2

Under eating disorders, there are several new codes for anorexia nervosa, restricting type (F50.010-F50.019), binge eating/purging type (F50.020-F50.029), bulimia nervosa (F50.20-F50.25), and binge eating disorder (F50.810-F50.819). Also new are F50.83 Pica in adults and F50.84 Rumination disorder in adults.

There are several new codes for diseases of the musculoskeletal system and connective tissue. New six-character codes were added to specify the location of pain under thoracic, thoracolumbar, and lumbosacral intervertebral disk disorders (M51).

Under synovitis and tenosynovitis (M65), several fifth- and sixth-character codes were added to allow the practitioner to specify the location of the unspecified synovitis and tenosynovitis.

An exclusion note was added to ICD-10-CM N39.0 (Urinary tract infection, site not specified). If the urinary tract infection is of a specified site, use one of the following: cystitis (N30.-), pyonephrosis (N13.6) or urethritis (N34.-).

One new code was added for anosognosia (R41.85). Patients with this condition are unaware of their health conditions or problems, often due to dementia or Alzheimer’s.

Two new social determinants of health codes for insufficient health insurance coverage (Z59.71) or welfare support (Z59.72) were added.

The change expected to impact urgent care the most is changes to report body mass index (BMI) for pediatric patients. Two codes were added for identifying pediatric BMI percentiles. The descriptions for this range of codes are now:

• Z68.51 Body mass index [BMI] pediatric, less than 5th percentile for age
• Z68.52 Body mass index [BMI] pediatric, 5th percentile to less than 85th percentile for age
• Z68.53 Body mass index [BMI] pediatric, 85th percentile to less than 95th percentile for age
• Z68.54 Body mass index [BMI] pediatric, 95th percentile for age to less than 120% of the 95th percentile for age
• Z68.55 Body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the95th percentile for age
• Z68.56 Body mass index [BMI] pediatric, greater than or equal to 140% of the 95th percentile for age

BMI pediatric codes are used for patients age 2 to 19 years of age. These percentiles are based on the growth charts published by the Centers for Disease Control and Prevention (CDC).

Remember to document and code as specifically as you can for a clean claim.