FY 2025 ICD-10 Coding and IPPS Updates

The Center for Medicare and Medicaid Services has released the FY 2025 updates to ICD-10-CM, ICD-10-PCS and the Inpatient Prospective Payment System (IPPS). Keeping pace with annual changes is a must for complete and accurate coding once the updates become valid on October 1, 2024. Coders have a responsibility to familiarize themselves with the changes to ensure they are equipped with the skills that lead to optimal performance in code selection.

To kick things off, here is a sample of updates for FY 2025.

ICD-10-CM

Guidelines

The updates to the guidelines this year are very minor with most just necessary to maintain consistency in how things are referenced in the guidelines based on the addition of new codes. Only one completely new guideline is being added.

Example:

The one new ICD-10-CM guideline for 2025 is I.C.4.a.1.(a) Presymptomatic Type 1 Diabetes Mellitus. This guideline is related to the addition of new codes to report presymptomatic type 1 diabetes mellitus. The new guideline simply indicates that codes from subcategory E10.A- are assigned for early-stage, type 1 diabetes the predates the onset of diabetic symptoms.

1) Type of diabetes

The age of a patient is not the sole determining factor, though most type 1 diabetics develop the condition before reaching puberty. For this reason, type 1 diabetes mellitus is also referred to as juvenile diabetes.

(a) 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.

Alphabetic Index

Most of the entries added to or deleted from the index are related to the addition of new codes or the addition of new inclusion terms under some codes. There are several instances though where the code directed for use by a particular search of the index has been changed.

Example:

When the terms Tumor, stromal, gastric and malignant are searched the index previously directed the assignment of code C16.9 Malignant neoplasm stomach, unspecified. The index now directs assignment of code C49.A2 Gastrointestinal stromal tumor of stomach.

No Change Tumor - see also Neoplasm, unspecified behavior, by site

Revise from - - - malignant C16.9

Revise to - - - malignant C49.A2

Tabular List

The greatest number of updates to ICD-10-CM for 2025 were made within the Tabular List. Updates consist primarily of adding new codes or expanding existing codes to provide greater specificity.

Example:

Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue

Codes for lumbar and lumbosacral intervertebral disc degeneration (M51.36 and M51.37) have been expanded to specify type of pain as

discogenic back pain only

lower extremity pain only

discogenic back pain and lower extremity pain

without mention of lumbar back pain or lower extremity pain

Excludes 1 notes have been added excluding these codes from being reported with codes M54.3, M54.4 and M54.5.

Code M65.9 Synovitis and tenosynovitis has been expanded to include specification of site and laterality.

There were also a notable number of updates to instructional notes, such as the addition of Code first, Code Also and Use Additional Code notes, and Excludes 1 notes being changed to Excludes 2 notes. When coders begin assigning codes on October 1, 2024, it is recommended to pay particular attention to reviewing any relevant instructional notes in the Tabular List for applicable changes.

ICD-10-PCS

Guidelines

There are no updates to the ICD-10-PCS Official Guidelines for Coding and Reporting for FY 2025.

Alphabetic Index

For 2025 Most of the entries added to or deleted from the index are related to changes in the tables such as the addition of new root operation, body part, device, substance or technology values, or the movement of devices and substances from one section of ICD-10-PCS to another. Some of the deletions and additions are made to correct errors.

Example:

Two new tables, X27 and X28, are being added to the New Technology section for 2025. Table X27 is being added to report insertion of drug-eluting resorbable scaffolding devices and the addition of table X28 goes along with the addition of the root operation “Division” in the Cardiovascular body system to allow for the reporting of Intraluminal Bioprosthetic Valve Leaflet Splitting procedures. An entry is being added to the ICD-10-PCS index that directs the coder to this table.

Code Tables

The greatest number of updates were made within the code tables themselves, with New Technology being the section with the most tables with updates.

Example

Introduction of Substances and Devices - There are 10 new substances and 3 new devices being added to the Introduction (XW0) table for New Technology Group 10.

• Substances
  • Anti-infectives
  • Anti-neoplastics
  • Immunotherapeutic agents
  • Anti-hypoglycemic
  • Anti-platelet effect reversal agent
  • Anti-diabetic
• Devices
  • Drug coated balloon for localized delivery of agent for percutaneous coronary intervention (PCI) to treat in-stent restenosis in coronary arteries
  • Temporary spacer system that uses irrigation with anti-infectives to treat periprosthetic fracture
  • Resorbable bone void filler for local restoration of bone weakened by osteoporosis

Inpatient Prospective Payment System (IPPS)

Payment Policies

CMS finalized extensive changes to the Hospital Inpatient Quality Reporting Program in the FY 2025 final rule.

Example:

CMS is finalizing an increase in the total number of electronic clinical quality measures (eCQMs) a hospital must report. Increases will occur with the 2026, 2027 and 2028 calendar year as outlined in this table and scoring of electronic CQM data for 2028 payment determinations to begin with calendar year 2025.

 MS-DRGs

For FY 2025 CMS has deleted 5 MS-DRGs, created 12 new MS-DRGs and revised the title of 4 MS-DRGs. The majority of changes are in MDC-08 Diseases and Disorders of the Musculoskeletal System and Connective Tissue.

Example:

New MS-DRG 317 Concomitant Left Atrial Appendage Closure and Cardiac Ablation was created to better accommodate the costs of concomitant left atrial appendage closure and cardiac ablation for atrial fibrillation.

• The largest number of cases moving into new MS-DRG 317 are moving out of MS-DRGs
  • 228 Other cardiothoracic procedures with MCC
  • 229 Other cardiothoracic procedures without MCC
  • 273 Percutaneous and other intracardiac procedures with MCC
  • 274 Percutaneous and other intracardiac procedures without MCC

NTAP

For 2025 there are 23 procedures from 2024 that have continued NTAP approval. 4 procedures were granted NTAP approval under the traditional pathway and 12 were granted approval under the alternative pathway. This makes a total of 39 procedures with approval for new technology add-on payment in 2025.

Example:

Here is a partial list of technologies whose NTAP is continuing from 2024

This is just a small taste of the extensive changes being implemented for FY 2025. We encourage everyone who works with the revenue cycle to review more comprehensive coverage of the updates to ensure you can hit the ground running when they become valid on October 1, 2024.

Prepare Now

Register now to enroll in HIALearn’s FY 2025 Code Update Series, including:

• FY 2025 ICD-10-CM Code Updates
• FY 2025 ICD-10-PCS Code Updates
• FY 2025 Inpatient Prospective Payment System (IPPS) Updates
• FY 2025 CPT and HOPPS Updates (Coming December 16, 2024)

Bundled pricing is available, don’t miss out!

Register for these essential courses by going to HIAlearn.com/code-updates

The information contained in this blog post is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.