April ICD-10 Changes | Michael Tidd, COS-C, HCS-D
CMS has announced changed to ICD-10 coding manual and Coding Guidelines effective April 1, 2025. There are NO actual changes to the ICD-10 code set. The changes are instead in the Alphabetic and Tabular Indexes within the coding manual. Most diagnosis coding manual vendors will send out a supplemental insert to those who purchase the 2025 coding manual that can be used until the new manual is released in August/September 2025 for the 2026 coding year.
The Alphabetic Index is the portion of the manual that is used to look up the disease processes in order to select the appropriate diagnosis code. These changes are limited to 3 key modifications; spelling corrections, indentation of index listings and alterations of the codes used for index listings. Failing to utilize these new Alphabetic changes will, in some cases, result in the incorrect diagnosis code being used.
Examples of changes are:
- Spelling corrections for “Pneumocystis (carinii)(jiroveci)” to “Pneumocystis (carinii)(jirovecii)”,
- Indentation of index listing “Level 1 E16.A1”, appearing below Decrease, to now appearing indented below “Glucose E16.2”.
- Changes of codes referenced “”Myocarditis – virus, viral I40.0” to “Myocarditis – virus, viral B33.22”
The Tabular Index is the actual code and vital instruction to ensure you have the correct code and it is being used correctly. This section has vital Code First, Use Additional Code, Excludes 1 and Excludes 2 direction. This is that largest portion, affecting 8 chapters, of the modifications in the April listing.
Examples of changes are:
- Addition to Use Additional code
- Addition to Excludes 1 listings
- Deletion of Excludes 1 listings
- Changes of Excludes 2 listings
- Spelling corrections such as “jirovecii” referenced above
- Addition of Code First listing
- Changes to 7th character instruction
Coding Guidelines, the instructions on how to code, have changed as well. Instruction for COVID and Obesity have changed and contain new coding information for these two areas.
COVID-19 guidelines have changed.
1.C.1.g.1.a – Code only confirmed cases
Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider. For a confirmed diagnosis, assign code U07.1, COVID-19. This is an exception to the hospital inpatient guideline Section II, H. In this context, “confirmation” does not require documentation of a positive test result for COVID-19; the provider’s documentation that the individual has COVID-19 is sufficient.
If the provider documents “suspected,” “possible,” “probable,” or “inconclusive” COVID-19, do not assign code U07.1. Instead, code the signs and symptoms reported. See guideline I.C.1.g.1.g.
1.C.1.g.1.h – Asymptomatic individuals who test positive for COVID-19
For asymptomatic individuals who test positive for COVID-19 and there is no provider documentation of a diagnosis of COVID-19, query the provider as to whether or not the individual has COVID-19. A false positive laboratory test is possible, and it is the provider’s responsibility to confirm the diagnosis and document accordingly.
Two new guidelines have been generated for Obesity and Overweight.
1.C.4.b Obesity
The obesity codes in category E66, Overweight and obesity, include codes related to the cause of obesity, such as drug-induced obesity (E66.1), and codes related to effects of obesity, such as code E66.2, Morbid (severe) obesity with alveolar hypoventilation. There are other codes related to obesity in other categories of the classification, such as E88.82, Obesity due to disruption of MC4R pathway; and codes in fifth character subcategory O99.21, Obesity complicating pregnancy, childbirth, and the puerperium.
1.C.4.b.1 – Obesity Class
The obesity class codes in subcategory E66.81, Obesity class, require a fifth character to convey the severity of obesity. The obesity class should be documented in the medical record by the provider for these codes to be assigned. The obesity class codes can be reported with other obesity codes in the classification found in Chapters 4 and 15 to fully describe the condition. However, if both class 3 obesity and morbid obesity are documented, only a code for class 3 obesity should be assigned as it is more specific.
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