ICD-10-CM: Key Revisions and Updates in the Code Set for 2025

The Centers for Medicare and Medicaid Services (CMS) annually updates diagnosis codes to reflect advancements in medical knowledge, technology, and evolving healthcare practices. These updates, often part of the ICD-10-CM code set, ensure accurate and comprehensive documentation of patient conditions, facilitating effective communication among healthcare providers, insurers, and researchers. New codes may address emerging diseases, change clinical terminology, or update diagnostic criteria, enhancing the precision of medical billing, reimbursement, and public health surveillance. Regular revisions enable healthcare systems to adapt to evolving healthcare landscapes, improving the overall quality of patient care and supporting informed decision-making.

For the fiscal year 2024, the Centers for Medicare and Medicaid Services (CMS) has introduced 395 new diagnosis codes, removed 25, and revised 13 within the ICD-10-CM code set. Additionally, the 2024 Addendum brought updates to various codes, particularly addressing osteoporosis with retinopathy, fractures, muscle entrapment in the eye, and nervous system diseases. In this blog, we provide you a sneak peek into these directives that will have a direct impact on accurate documentation, billing, and overall patient care.

External Causes of Morbidity (Chapter 20 of ICD 10 Codes) has 123 Changes.

Chapter 20 of the ICD-10-CM (International Classification of Diseases, 10th Edition, Clinical Modification) is dedicated to "External Causes of Morbidity" and encompasses codes V00 to Y99. This chapter provides a systematic way to classify various factors influencing health status and encounters with health services, excluding diseases and injuries. These codes are essential for capturing information related to external causes, such as accidents, self-harm, and other circumstances that may lead to injuries or health issues.

This year, Chapter 20 of the ICD-10-CM has undergone a major overhaul with 123 substantial revisions. The changes to this chapter constitute nearly half of the new codes introduced. The notable expansion focuses on diverse scenarios involving foreign bodies, ranging from plastic, batteries, metal, and glass objects (both magnetic and non-magnetic) to organic and non-organic items, as well as sharp objects penetrating through natural orifices. 

With these changes, healthcare professionals and researchers need to be more careful in gathering data pertaining to the circumstances surrounding external injuries involving foreign bodies.

Diseases of the Musculoskeletal System and Connective Tissue (Chapter 13 of ICD 10 Codes) has 42 Coding Changes.

In the ICD-10-CM coding system, Chapter 13 is titled "Diseases of the Musculoskeletal System and Connective Tissue." This chapter encompasses codes M00 to M99 and includes diverse conditions related to bones, muscles, joints, and connective tissues. Some examples of conditions covered in Chapter 13 include arthritis, osteoporosis, musculoskeletal injuries, and various other disorders affecting the musculoskeletal system.

For the year 2024, the ICD-10-CM introduces 42 novel codes. The codes aim to refine the classification of osteoporosis with pathological fracture. The classification of osteoporosis with pathological fracture holds significant importance for various aspects of healthcare. It would allow healthcare professionals to precisely document the specific nature of osteoporosis-related fractures and determine appropriate treatment plans and interventions tailored to individual patient needs. Additionally, the classification is instrumental in treatment planning, where different types of fractures may necessitate distinct therapeutic approaches. With changes to coding, it would now be possible to aid in tailoring strategies that consider factors such as malunion, nonunion, delayed healing, or routine healing, optimizing outcomes for patients with osteoporosis-related fractures.

Factors Influencing Health Status and Contact with Health Services (Chapter 21 of ICD-10 Codes) has 36 Coding Changes. 

Chapter 21, Z00-Z99, encompasses a broad range of codes not classified as diseases or injuries. These codes are related to various factors influencing an individual's health status and interactions with the healthcare system. This chapter includes codes for encounters for routine examinations, various health screenings, vaccinations, counseling, and factors influencing health, such as family history and lifestyle.

In 2024, Chapter 21 of the ICD-10-CM added 30 new codes and removed six old ones. Noteworthy additions encompass codes for observing newborns for suspected conditions ruled out, individuals identified as carriers of Acinetobacter baumannii bacteria, encounters for prophylactic measures, and family history of specific colon polyps. Additionally, new codes address the caregiver's non-compliance type, and Social Determinants of Health (SDoH) has been enriched with additions such as codes for child custody and parental/adult-child conflict. These modifications contribute to a more comprehensive and nuanced classification system, facilitating precise documentation and analysis of various health-related factors and encounters.

Diseases of the Eye and Adnexa (Chapter 7 of ICD-10 Codes) has 35 Coding Changes.

In the ICD-10-CM coding system, Chapter 7 is designated for "Diseases of the Eye and Adnexa." This chapter covers a comprehensive range of conditions related to ocular health, including disorders affecting the eyeball, eyelids, lacrimal system, and other associated structures. Codes H00 to H59 are utilized to classify various eye diseases and conditions. Examples of conditions within this chapter include conjunctivitis, cataracts, glaucoma, disorders of the eyelids, and other ocular abnormalities.

In 2024, coding changes introduced to Chapter 7 include adding 34 new codes and deleting one. The overarching objective is to improve the specificity of eye-related condition classification. A few notable additions involve codes for non-proliferative and proliferative sickle-cell retinopathy, expanded coverage for other forms of strabismus with a focus on specific eye muscle entrapment, and incorporation of foreign body sensation codes. Furthermore, the updates accommodate considerations for laterality, refining the coding system to capture nuances in eye-related disorders more accurately. These modifications are expected to contribute to a nuanced understanding of eye health for healthcare professionals and researchers.

Other Changes

Other major changes have also been made to Chapter 6 and Chapter 17 of ICD-10. While Chapter 6, which covers "Diseases of the Nervous System" (G00-G99), has 24 new codes to enhance the classification of various neurological conditions, Chapter 17, which addresses "Congenital Malformations, Deformations, and Chromosomal Abnormalities" (Q00-Q99), have seen the inclusion of 22 new codes and the revision of six existing codes. 

Conclusion

The modifications that have kicked in from 2024 are expected to contribute to a more refined classification of congenital and non-congenital conditions. It will go a long way in ensuring that the coding system remains current and comprehensive in capturing the diverse spectrum of disease, malformations, deformities, abnormalities, accidents etc.

Invensis, a specialized healthcare bpo service provider, has seamlessly navigated the dynamic alterations to ICD-10 codes since 2015. In 2024, like every year, we are committed to staying current and adapting to all the new changes. This makes us an ideal partner for outsourcing coding services.