The Centers for Medicare & Medicaid Services (CMS) unveiled updated ICD-10-CM and ICD-10-PCS codes effective October 1, 2024. The revisions will help track disease prevalence and treatment outcomes effectively. Healthcare providers must understand any revisions to these codes to sustain revenue integrity. This article explores the context behind CMS’s changes.
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Editor's Note: This article is based on information presented during the following webinars: Insight Into the 2025 ICD-10 CM Updates and Insight Into the 2025 ICD-10 PCS Updates, presented by Mikki Fazzio, RHIT, CCS, Charge Integrity Specialist, Health Catalyst.
The Centers for Medicare & Medicaid Services (CMS) has announced the fiscal year (FY) 2025 updates regarding the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and International Classification of Diseases, 10th Revision Procedure Coding System (ICD-10-PCS). These alphanumeric codes represent the framework for capturing and reporting diagnoses, health interventions, and procedures.
Healthcare providers are required to implement these codes for patient discharges and encounters effective October 1, 2024. Preparation is essential for adhering to the new coding guidelines and for medical coders and healthcare professionals to optimize billing and reimbursement.
This article explores:
The FY 2025 updates include more ICD-10-CM codes, from 73,674 to 74,044. This includes 395 ICD-10-CM additions, 13 revisions, and 25 deletions. Additionally, CMS added 429 new Present on Admission (POA) exempt codes and eliminated eight POA exempt codes.
As part of these changes, CMS released revisions to the ICD-10-CM codes across numerous chapters. These changes aim to enhance precision in coding various health conditions while correcting errors and expanding classifications to reflect emerging medical knowledge.
For instance, Chapter 1 includes revised codes related to certain infectious and parasitic diseases to correct spelling errors in the Ehrlichiosis group.
Further advancements can be seen in Chapter 2, where new codes have been introduced to differentiate between Hodgkin and non-Hodgkin lymphomas based on remission status. Additionally, chapters covering blood disorders introduce a new code for Fanconi anemia—a rare, inheritable condition leading to severe bone marrow failure.
These coding refinements underscore the growing recognition of rare diseases in medical literature and are expected to improve accuracy in tracking disease prevalence and treatment outcomes.
Other notable updates include expanded diabetes subcategory codes under Chapter 4, which now account for presymptomatic stages of Type 1 diabetes and clinical severity indicators for hypoglycemia.
The updates also extend into mental health, with revised coding structures within Chapter 5 that categorize eating disorders by severity and remission stages.
New specifications for KCNQ2-related epilepsy and serotonin syndrome emerge from Chapter 6, further exemplifying the ICD-10-CM's adaptation to incorporate a nuanced understanding of neurological conditions.
Chapter 21 sees an expansion aimed at genetic susceptibility concerning health factors such as obesity and epilepsy and tracking personal histories regarding sepsis risks.
CMS announced updates to the Medicare Severity Diagnosis Related Group (MS-DRG) system, which aims to improve the classification and specificity of complex medical procedures.
Among the notable changes was the creation of a new base MS-DRG 317, specifically designed for cases involving concomitant left atrial appendage closure (LAAC) and cardiac ablation procedures. Unlike many existing groupings divided into severity levels based on average costs, MS-DRG 317 will maintain a single level due to a lack of cost variation between these severity levels. This adjustment reflects an ongoing effort to streamline billing processes while providing a better representation of patient care complexity.
Further adjustments included updates in multiple Major Diagnostic Categories (MDCs). In MDC 06, for instance, procedures previously categorized under MS-DRGs 347 to 349 have been reclassified into MS-DRGs focused on major small and large bowel procedures.
Similarly, MDC 08 sees changes with interbody spinal fusion procedures being entirely restructured; three old DRGs have been eliminated in favor of eight new ones that aim to cover more specific surgical interventions and their associated complexities. Additionally, CMS added five diagnosis codes related to deforming dorsopathies to the logic list for these DRGs, enhancing clarity in cases treated under existing spinal surgery classifications.
Other revisions extend across several MDCs, including endocrine disorders and myeloproliferative diseases and disorders.
The FY 2025 updates to the ICD-10-PCS system introduced significant changes aimed at enhancing medical coding accuracy in the face of evolving healthcare technologies.
With the addition of 371 new codes and the deletion of 61, the total number of ICD-10-PCS codes now stands at an impressive 78,948. These updates emphasize the integration of innovative surgical tools, vital testing procedures, and advanced treatment techniques into the coding system. Yet, this year's update does not revise existing titles or guidelines.
One notable area affected by these updates is the Medical and Surgical Section, which encompasses a wide array of body systems—from the central nervous system and cranial nerves to the lower arteries and lymphatic system.
Other impacted areas include advances in procedures concerning the hepatobiliary system and pancreas, as well as modifications related to skin treatments. The inclusion of new codes reflects not only technological advancements but also a commitment to ensure that emerging medical practices are accurately represented in health records.
Indeed, exciting developments in medical technology and surgical procedures are on the horizon as healthcare providers prepare to integrate innovations into their practices. To that end, under the Medical and Surgical category, CMS highlighted several of these new approaches to improve coding accuracy for emerging medical technologies.
Among the most notable advancements is the OneRF™ Ablation System, which employs stereoelectroencephalographic (sEEG) radiofrequency ablation to target and destroy brain tissue associated with epilepsy. This pioneering technique significantly reduces seizure activity by carefully mapping out neuronal connections before intervention, ultimately offering new hope for patients whose conditions have not responded to conventional therapies.
In addition, the introduction of Quicktome represents a breakthrough in pre-surgical planning. This tool converts MRI sequences into comprehensive 3D maps illustrating white matter tracts within an individual's brain. By allowing connectomic analysis of unique networks responsible for language, movement, thought, and emotion, Quicktome enhances surgeons' understanding of a patient's neurological landscape before any surgical intervention.
Another notable advancement is the LumiGuide for fiber optic 3D guidance during endovascular procedures. This technology provides 3D images of inside the vessel during a procedure to help direct the catheter into the branch vessels.
Similarly, advances such as the Lymphatic System Bypass procedure are designed to effectively combat lymphedema through newly established pathways between lymphatic vessels and veins, relieving this often-debilitating condition.
These updates collectively underscore a solid commitment to enhancing coding accuracy amidst rapidly evolving treatment approaches and technological advancements. With the introduction of new codes and revisions to existing ones, it is essential for providers to stay informed about these updates to ensure proper documentation and coding.
As these revisions roll out nationwide, with the hopes of improving diagnosis accuracy and patient care management and documentation strategies, healthcare professionals will need comprehensive solutions and training on these updated codes to ensure proper implementation across practices.
For a comprehensive list of new codes and revisions to existing codes, including major complication or comorbidity (MCC) and complication or comorbidity (CC) diagnosis codes, please watch Insight Into the 2025 ICD-10 CM Updates (Part 1 of 2) and Insight Into the 2025 ICD-10 PCS Updates (Part 2 of 2).
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