As the healthcare landscape evolves, so must the tools that keep it running smoothly. One of the most crucial tools in medical practice is the ICD-10-CM code set, which gets updated annually to reflect new diagnoses, treatment approaches, and health risks. The 2025 updates, effective October 1, 2024, bring new codes and significant changes to the official coding guidelines. And it will remain in use through September 30, 2025.
In this post, we’ll explore how the ICD-10-CM updates (2025) affect your practice, the fundamental changes, and how you can ensure compliance in the year ahead.
THE IMPACT ON MEDICAL PRACTICES
The 2025 ICD-10-CM guideline changes bring essential updates impacting medical practices across various specialties. These revisions refine the coding system to enhance specificity and accuracy in diagnosing and documenting patient conditions. One of the primary changes includes adding new codes and revisions to existing codes, allowing healthcare providers to capture more precise details about a patient’s diagnosis. This impacts medical practices by ensuring better alignment between clinical documentation and coding, thus improving patient care and outcomes.
The 2025 updates also emphasize the importance of social determinants of health (SDOH). Medical practices must document non-medical factors affecting a patient’s health, such as socioeconomic status, access to healthcare, and environmental conditions. This change encourages providers to take a more holistic approach to patient care, leading to more comprehensive treatment plans. Accurate SDOH coding may impact reimbursement rates and help identify population health trends.
Additionally, the new guidelines include updates to specific disease categories, particularly in areas like oncology, cardiology, and mental health. Medical practices must stay up to date with these changes to avoid coding errors, which could lead to claim denials or delays in reimbursement
THE KEY CHANGES
Section I.C.1.d.5(b) Sepsis due to a postprocedural infection
For sepsis following a postprocedural wound (surgical site) infection, a code from T81.41 to T81.43, Infection following a procedure, T81.49, Infection following a procedure, other surgical site, or a code from O86.00 to O86.03, Infection of obstetric surgical wound, or code O86.09, Infection of obstetric surgical wound, other surgical site, that identifies the site of the infection should be sequenced first, if known.
Section I.C.1.g.1(g) Coronavirus Infections, Signs and symptoms without definitive diagnosis of COVID-19
If a patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to COVID-19, assign Z20.828 Z20.822, Contact with and (suspected) exposure to other viral communicable diseases COVID-19, as an additional code.
Section I.C.2.m. Current malignancy versus personal history of malignancy
Codes from subcategories Z85.0 – Z85.7 Z85.85 should only be assigned for the former site of a primary malignancy, not the site of a secondary malignancy. Code Z85.89 may be assigned for the former site(s) of either a primary or secondary malignancy.
Section I.C.2.s. Breast implant-associated anaplastic large cell lymphoma
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a type of lymphoma that can develop around breast implants. Assign code C84.7A, Anaplastic large cell lymphoma, ALK-negative, breast, for BIA-ALCL or C84.7B, Anaplastic large cell lymphoma, ALK-negative, in remission, for BIA-ALCL in remission. Do not assign a complication code from chapter 19.
Section I.C.2.t. Secondary malignant neoplasm of lymphoid tissue
When a malignant neoplasm of lymphoid tissue metastasizes beyond the lymph nodes, a code from categories C81-C85 with a final character identifying “9” should be assigned “extranodal and solid organ sites” should be assigned rather than a code for the secondary neoplasm of the affected solid organ. For example, for metastasis of diffuse large B-cell lymphoma to the lung, brain, and left adrenal gland, assign code C83.398, Diffuse large B-cell lymphoma of other extranodal and solid organ sites.
Section I.C.4.a.1.(a) Presymptomatic type 1 Diabetes Mellitus
Presymptomatic Type 1 Diabetes Mellitus Codes E10.A-, Type 1 diabetes mellitus, presymptomatic, are assigned for early-stage type 1 diabetes that predates the onset of symptoms.
Section I.C.7.a.3. Bilateral glaucoma stage with different types or stages
When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and there is a code for bilateral glaucoma, report only the code for the type of glaucoma, bilateral, with the seventh character for the stage.
When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and the classification does not provide a code for bilateral glaucoma (i.e. subcategories H40.10, H40.11, and H40.20) report only one code for the type of glaucoma with the appropriate seventh character for the stage.
Section I.C.9.e.1. Type 1 ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI)
The ICD-10-CM codes for type 1 acute myocardial infarction (AMI) identify the site, such as anterolateral wall or true posterior wall. Subcategories I21.0-I21.2 and code I21.3 are used for type 1 ST elevation myocardial infarction (STEMI). Code I21.4, Non-ST elevation (NSTEMI) myocardial infarction, is used for type 1 non-ST elevation myocardial infarction (NSTEMI) and nontransmural MIs.
If a type 1 NSTEMI evolves to STEMI, assign the STEMI code. If a type 1 STEMI converts to NSTEMI due to thrombolytic therapy, it is still coded as STEMI.
Section I.C.9.e.5. Other Types of Myocardial Infarction
Type 2 myocardial infarction (myocardial infarction due to demand ischemia or secondary to ischemic imbalance) is assigned to code I21.A1, Myocardial infarction type 2 with the underlying cause coded first, if applicable. Do not assign code I24.89, Other forms of acute ischemic heart disease, for the demand ischemia. If a type 2 AMI is described as NSTEMI or STEMI, only assign code I21.A1. Codes I21.01-I21.4 should only be assigned for type 1 AMIs.
Section I.C.14.a.1 Stages of chronic kidney disease (CKD)
The ICD-10-CM classifies CKD based on severity. The severity of CKD is designated by stages 1-5. Stage 2, code N18.2, equates to mild CKD; stage 3, codes N18.30-N18.32, equate to moderate CKD; and stage 4, code N18.4, equates to severe CKD. Code N18.6, End stage renal disease (ESRD), is assigned when the provider has documented end-stage renal disease (ESRD). If both a stage of CKD and ESRD are documented, assign code N18.6 only.
Section I.C.21.14 Miscellaneous Z Codes
Z55 Problems related to education and literacy
Z56 Problems related to employment and unemployment
Z57 Occupational exposure to risk factors
Z58 Problems related to physical environment
Z59 Problems related to housing and economic circumstances
Z60 Problems related to social environment
Z62 Problems related to upbringing
Z63 Other problems related to primary support group, including family instances
Section I.C.21.16 Z Codes that may only be Principal/First-listed diagnosis
Z03 Encounter for medical observation for suspected diseases and conditions ruled out
STRATEGIES FOR ENSURING COMPLIANCE
WITH 2025 ICD-10-CM GUIDELINES
To ensure compliance with the 2025 ICD-10-CM guidelines, it is crucial to first thoroughly review and understand the changes. This involves studying the updated codes, revisions, and new regulations. Subscribing to authoritative sources, attending training sessions, and leveraging resources such as webinars and industry publications can help you stay current. This ensures that both providers and coding professionals have a solid understanding of the new requirements.
Staff training is another critical element in maintaining compliance. Providing all team members involved in coding, billing, and documentation access to continuous education on the updated guidelines is essential. Holding regular workshops or training sessions—both in-person and online—will enable staff to become proficient with the 2025 ICD-10-CM updates. This reduces the chances of coding errors that could lead to claim denials, delays in reimbursement, or penalties due to non-compliance. Training should focus not only on new codes but also on documentation best practices to ensure that all patient records are complete and accurate.
Implementing internal audits is another vital strategy. Regular audits of your coding practices will allow you to identify potential issues before they escalate. These audits can help ensure that codes are used correctly and that documentation aligns with the new guidelines. By catching mistakes early, medical practices can reduce the risk of compliance failures and improve coding accuracy, leading to fewer insurer rejections and higher reimbursement rates.
Finally, leveraging technology will ensure compliance with the 2025 ICD-10-CM guidelines. Investing in practice management or coding software updated regularly to reflect the latest guidelines can streamline the coding process and help identify potential compliance issues automatically. Such systems often have built-in alerts or checks that ensure codes are entered correctly and documentation complete. This reduces the risk of errors and enhances efficiency in managing patient records and processing claims.
In conclusion, ensuring compliance with the 2025 ICD-10-CM guidelines requires a comprehensive approach that includes staying informed about the latest changes, investing in staff training, conducting regular internal audits, and leveraging technology. By thoroughly understanding the updates and implementing ongoing education and auditing processes, medical practices can avoid costly errors and improve coding accuracy. Utilizing advanced practice management and coding software will further streamline operations, reduce non-compliance risk, and enhance overall efficiency. Through these strategies, healthcare organizations can remain compliant and deliver higher-quality care while optimizing reimbursement and minimizing administrative burdens.
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