Vitalware-Insight-Into-the-2025-ICD10-CM-Updates.pptx

Prepare for mandatory ICD-10 CM diagnosis code updates, which take effect on October 1, 2024. By attending this 60-minute educational session. Medical coders and healthcare professionals will gain a comprehensive understanding of the changes to the 2025 ICD-10 diagnosis codes and their guidelines, along with major complication or comorbidity (MCC), complication or comorbidity (CC), and Medicare Severity Diagnosis Related Groups (MS-DRGs) classification changes. With this information, professionals can ensure accurate and compliant diagnosis coding for optimal billing and reimbursement. The second installment of this 2-part complimentary series will take place on September 19, 2024, focusing on recent updates to ICD-10-PCS code sets.

1. Insight into the 2025 ICD-10-CM Updates Mikki Fazzio, RHIT, CCS, Charge Integrity Specialist

2. Disclaimer Statement This presentation was current at the time it was published or provided via the web and is designed to provide accurate and authoritative information regarding the subject matter covered. The information provided is only intended to be a general overview with the understanding that neither the presenter nor the event sponsor is engaged in rendering specific coding advice. It is not intended to take the place of either the written policies or regulations. We encourage participants to review the specific regulations and other interpretive materials, as necessary. All CPT® codes are trademarked by the American Medical Association (AMA) and all revenue codes are copyrighted by the American Hospital Association (AHA).

3. MCC/CC Changes ICD-10-CM Chapter-Specific Code Additions, Deletions, and Revisions ICD-10-CM Guideline Changes MS-DRG Updates

4. CM Code Changes Summary- FY 2025 Total CM codes from 73,674 to 74,044 395 new codes 13 revisions 25 deletions 429 new POA exempt codes added, 8 POA exempt codes deleted MCC/CC Changes: 4 new MCCs No deleted MCCs 104 new CCs 18 deleted CCs

5. MCC/CC Changes

6. MCC and CC Changes- MCC Additions *There were no MCC deletions for FY 2025.

7. MCC and CC Changes- CC Additions

8. MCC and CC Changes- CC Additions

9. MCC and CC Changes- CC Additions

10. MCC and CC Changes- CC Additions

11. MCC and CC Changes- CC Additions

12. MCC and CC Changes- CC Deletions

13. ICD-10-CM Chapter Specific Code Additions, Deletions, and Revisions

14. Revision Revise from: A77.41 Ehrlichiosis chafeensis [E. chafeensis ] Revise to: A77.41 Ehrlichiosis cha ff eensis [E. cha ff eensis ] Chapter 1: Certain Infectious and Parasitic Diseases ICD-10-CM Code Additions, Deletions, and Revisions

15. Lymphoma- Cancer of the lymphatic system, which is part of the immune system Occurs when lymphocytes or white blood cells grow out of control Two main types: Hodgkin lymphoma and Non-Hodgkin lymphoma Complete remission= all evidence of disease is eliminated Chapter 2: Neoplasms ICD-10-CM Code Additions, Deletions, and Revisions https://www.cancercenter.com/lymphoma

16. Additions C81.0A Nodular lymphocyte predominant Hodgkin lymphoma, in remission C81.1A Nodular sclerosis Hodgkin lymphoma, in remission C81.2A Mixed cellularity Hodgkin lymphoma, in remission C81.3A Lymphocyte depleted Hodgkin lymphoma, in remission C81.4A Lymphocyte-rich Hodgkin lymphoma, in remission C81.7A Other Hodgkin lymphoma, in remission C81.9A Hodgkin lymphoma, unspecified, in remission Chapter 2: Neoplasms ICD-10-CM Code Additions, Deletions, and Revisions

17. Additions C82.0A Follicular lymphoma grade I, in remission C82.1A Follicular lymphoma grade II, in remission C82.2A Follicular lymphoma grade III, unspecified, in remission C82.3A Follicular lymphoma grade IIIa, in remission C82.4A Follicular lymphoma grade IIIb , in remission C82.5A Diffuse follicle center lymphoma, in remission C82.6A Cutaneous follicle center lymphoma, in remission C82.8A Other types of follicular lymphoma, in remission C82.9A Follicular lymphoma, unspecified, in remission Chapter 2: Neoplasms ICD-10-CM Code Additions, Deletions, and Revisions

18. Additions C83.0A Small cell B-cell lymphoma, in remission C83.1A Mantle cell lymphoma, in remission C83.390 Primary central nervous system lymphoma C83.398 Diffuse large B-cell lymphoma of other extranodal and solid organ sites C83.3A Diffuse large B-cell lymphoma, in remission C83.5A Lymphoblastic (diffuse) lymphoma, in remission C83.7A Burkitt lymphoma, in remission C83.8A Other non-follicular lymphoma, in remission C83.9A Non-follicular (diffuse) lymphoma, unspecified, in remission [ Deletion : C83.39 Diffuse large B-cell lymphoma, extranodal and solid organ sites] Chapter 2: Neoplasms ICD-10-CM Code Additions, Deletions, and Revisions

19. Additions C84.0A Mycosis fungoides, in remission C84.1A Sezary disease, in remission C84.4A Peripheral T-cell lymphoma, not elsewhere classified, in remission C84.6A Anaplastic large cell lymphoma, ALK-positive, in remission C84.7B Anaplastic large cell lymphoma, ALK-negative, in remission C84.9A Mature T/NK-cell lymphomas, unspecified, in remission C84.AA Cutaneous T-cell lymphoma, unspecified, in remission C84.ZA Other mature T/NK-cell lymphomas, in remission Chapter 2: Neoplasms ICD-10-CM Code Additions, Deletions, and Revisions

20. Additions C85.1A Unspecified B-cell lymphoma, in remission C85.2A Mediastinal (thymic) large B-cell lymphoma, in remission C85.8A Other specified types of non-Hodgkin lymphoma, in remission C85.9A Non-Hodgkin lymphoma, unspecified, in remission C86.00 Extranodal NK/T-cell lymphoma, nasal type not having achieved remission C86.01 Extranodal NK/T-cell lymphoma, nasal type, in remission C86.10 Hepatosplenic T-cell lymphoma not having achieved remission C86.11 Hepatosplenic T-cell lymphoma, in remission [ Deletions : C86.0 Extranodal NK/T-cell lymphoma, nasal type; C861 Hepatosplenic T-cell lymphoma] Chapter 2: Neoplasms ICD-10-CM Code Additions, Deletions, and Revisions

21. Additions C86.20 Enteropathy-type (intestinal) T-cell lymphoma not having achieved remission C86.21 Enteropathy-type (intestinal) T-cell lymphoma, in remission C86.30 Subcutaneous panniculitis-like T-cell lymphoma not having achieved remission C86.31 Subcutaneous panniculitis-like T-cell lymphoma, in remission C86.40 Blastic NK-cell lymphoma not having achieved remission C86.41 Blastic NK-cell lymphoma, in remission C86.50 Angioimmunoblastic T-cell lymphoma not having achieved remission C86.51 Angioimmunoblastic T-cell lymphoma, in remission [ Deletions : C86.2 Enteropathy-type (intestinal) T-cell lymphoma; C86.3 Subcutaneous panniculitis-like T-cell lymphoma; C86.4 Blastic NK-cell lymphoma; C86.5 Angioimmunoblastic T-cell lymphoma] Chapter 2: Neoplasms ICD-10-CM Code Additions, Deletions, and Revisions

22. Additions C86.60 Primary cutaneous CD30-positive T-cell proliferations not having achieved remission C86.61 Primary cutaneous CD30-positive T-cell proliferations, in remission C88.00 Waldenstrom macroglobulinemia not having achieved remission C88.01 Waldenstrom macroglobulinemia, in remission C88.20 Heavy chain disease not having achieved remission C88.21 Heavy chain disease, in remission C88.30 Immunoproliferative small intestinal disease not having achieved remission C88.31 Immunoproliferative small intestinal disease, in remission [ Deletions : C86.6 Primary cutaneous CD30-positive T-cell proliferations; C88.0 Waldenstrom macroglobulinemia; C88.2 Heavy chain disease; C88.3 Immunoproliferative small intestinal disease] Chapter 2: Neoplasms ICD-10-CM Code Additions, Deletions, and Revisions

23. Additions C88.40 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT- lymphoma] not having achieved remission C88.41 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT- lymphoma], in remission C88.80 Other malignant immunoproliferative diseases not having achieved remission C88.81 Other malignant immunoproliferative diseases, in remission C88.90 Malignant immunoproliferative disease, unspecified not having achieved remission C88.91 Malignant immunoproliferative disease, unspecified, in remission [ Deletions : C88.4 Extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue [MALT-lymphoma]; C88.8 Other malignant immunoproliferative diseases; C88.9 Malignant immunoproliferative disease, unspecified] Chapter 2: Neoplasms ICD-10-CM Code Additions, Deletions, and Revisions

24. Addition D61.03 Fanconi anemia Rare, inherited condition that affects the bone marrow and causes gradual bone marrow failure Causes multiple physical abnormalities Normally symptoms appear at birth or early childhood Patients have increased risk of developing blood disorders and some types of cancers Fanconi anemia is different than Fanconi syndrome and is coded differently Chapter 3: Diseases of Blood/Blood-Forming Organs & Disorders Involving Immune Mechanism ICD-10-CM Code Additions, Deletions, and Revisions

25. Chapter 4: Endocrine, Nutritional and Metabolic Diseases ICD-10-CM Code Additions, Deletions, and Revisions CMS Coordination and Maintenance meetings September 2023

26. Additions E10.A0 Type 1 diabetes mellitus, presymptomatic, unspecified E10.A1 Type 1 diabetes mellitus, presymptomatic, Stage 1 E10.A2 Type 1 diabetes mellitus, presymptomatic, Stage 2 E16.A1 Hypoglycemia level 1 (<70 mg per dl) E16.A2 Hypoglycemia level 2 (<54 mg per dl) E16.A3 Hypoglycemia level 3 (altered mental status and/or physical functioning) Chapter 4: Endocrine, Nutritional and Metabolic Diseases ICD-10-CM Code Additions, Deletions, and Revisions

27. Carcinoid Syndrome A carcinoid tumor is a type of neuroendocrine tumor Occurs most often in GI tract or lungs Tumor secretes serotonin or other chemicals into bloodstream Carcinoid syndrome occurs in people who have carcinoid tumors that have advanced Chapter 4: Endocrine, Nutritional and Metabolic Diseases ICD-10-CM Code Additions, Deletions, and Revisions

28. Additions E34.00 Carcinoid syndrome, unspecified E34.01 Carcinoid heart syndrome E34.09 Other carcinoid syndrome [ Deletion : E34.0 Carcinoid syndrome] Chapter 4: Endocrine, Nutritional and Metabolic Diseases ICD-10-CM Code Additions, Deletions, and Revisions

29. Additions E66.811 Obesity, class 1 E66.812 Obesity, class 2 E66.813 Obesity, class 3 E66.89 Other obesity not elsewhere classified E74.820 SLC13A5 Citrate Transporter Disorder Rare, genetic disease with neurologic symptoms, motor and cognitive impairment E74.829 Other disorders of citrate metabolism E88.82 Obesity due to disruption of MC4R pathway Most common genetic cause of obesity [ Deletion : E66.8 Other obesity] Chapter 4: Endocrine, Nutritional and Metabolic Diseases ICD-10-CM Code Additions, Deletions, and Revisions Obesity class identified based on patient’s BMI.

30. Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders ICD-10-CM Code Additions, Deletions, and Revisions Additions F50.010 Anorexia nervosa, restricting type, mild F50.011 Anorexia nervosa, restricting type, moderate F50.012 Anorexia nervosa, restricting type, severe F50.013 Anorexia nervosa, restricting type, extreme F50.014 Anorexia nervosa, restricting type, in remission F50.019 Anorexia nervosa, restricting type, unspecified [ Deletion : F50.01 Anorexia nervosa, restricting type]

31. Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders ICD-10-CM Code Additions, Deletions, and Revisions Additions F50.020 Anorexia nervosa, binge eating/purging type, mild F50.021 Anorexia nervosa, binge eating/purging type, moderate F50.022 Anorexia nervosa, binge eating/purging type, severe F50.023 Anorexia nervosa, binge eating/purging type, extreme F50.024 Anorexia nervosa, binge eating/purging type, in remission F50.029 Anorexia nervosa, binge eating/purging type, unspecified [ Deletion : F50.02 Anorexia nervosa, binge eating/purging type]

32. Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders ICD-10-CM Code Additions, Deletions, and Revisions Additions F50.20 Bulimia nervosa, unspecified F50.21 Bulimia nervosa, mild F50.22 Bulimia nervosa, moderate F50.23 Bulimia nervosa, severe F50.24 Bulimia nervosa, extreme F50.25 Bulimia nervosa, in remission [ Deletion : F50.2 Bulimia nervosa]

33. Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders ICD-10-CM Code Additions, Deletions, and Revisions Additions F50.810 Binge eating disorder, mild F50.811 Binge eating disorder, moderate F50.812 Binge eating disorder, severe F50.813 Binge eating disorder, extreme F50.814 Binge eating disorder, in remission F50.819 Binge eating disorder, unspecified [ Deletion : F50.81 Binge eating disorder]

34. Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders ICD-10-CM Code Additions, Deletions, and Revisions Additions F50.83 Pica in adults Eating things that aren’t considered food F50.84 Rumination disorder in adults Regurgitating food Revision Revise from: F98.21 Rumination disorder of infancy Revise to: F98.21 Rumination disorder of infancy and childhood

35. Additions KCNQ2-related epilepsy is named after the gene that is affected Involves multiple daily seizures Seizures typically disappear in childhood G40.841 KCNQ2-related epilepsy, not intractable, with status epilepticus G40.842 KCNQ2-related epilepsy, not intractable, without status epilepticus G40.843 KCNQ2-related epilepsy, intractable, with status epilepticus G40.844 KCNQ2-related epilepsy, intractable, without status epilepticus Chapter 6: Diseases of the Nervous System ICD-10-CM Code Additions, Deletions, and Revisions

36. Additions G90.81 Serotonin syndrome Excess serotonin in the central nervous system G90.89 Other disorders of autonomic nervous system [ Deletion : G90.8 Other disorders of autonomic nervous system] Chapter 6: Diseases of the Nervous System ICD-10-CM Code Additions, Deletions, and Revisions

37. Additions G93.45 Developmental and epileptic encephalopathy Commonly begins in infancy or childhood Frequent seizures of different types, intellectual disability, significant developmental delay, regression, or plateau Chapter 6: Diseases of the Nervous System ICD-10-CM Code Additions, Deletions, and Revisions

38. Revision Revise from: G93.42 Megaloencephalic leukoencephalopathy with subcortical cysts Revise to: G93.42 Megalencephalic leukoencephalopathy with subcortical cysts Chapter 6: Diseases of the Nervous System ICD-10-CM Code Additions, Deletions, and Revisions

39. Additions I26.03 Cement embolism of pulmonary artery with acute cor pulmonale Complication of cement leaking into the vertebral venous plexus and pulmonary arteries I26.04 Fat embolism of pulmonary artery with acute cor pulmonale Fat globules are released into circulation and occlude the pulmonary blood vessels I26.95 Cement embolism of pulmonary artery without acute cor pulmonale I26.96 Fat embolism of pulmonary artery without acute cor pulmonale Chapter 9: Diseases of the Circulatory System ICD-10-CM Code Additions, Deletions, and Revisions

40. Chapter 9: Diseases of the Circulatory System ICD-10-CM Code Additions, Deletions, and Revisions

41. Revision Revise from: I26.93 Single subsegmental pulmonary embolism without acute cor pulmonale Revise to: I26.93 Single subsegmental thrombotic pulmonary embolism without acute cor pulmonale Revise from: I26.94 Multiple subsegmental pulmonary emboli without acute cor pulmonale Revise to: I26.94 Multiple subsegmental thrombotic pulmonary emboli without acute cor pulmonale Chapter 9: Diseases of the Circulatory System ICD-10-CM Code Additions, Deletions, and Revisions

42. Revision Revise from: H44.2A3 Degenerative myopia with choroidal neovascularization, bilateral eye Revise to: H44.2A3 Degenerative myopia with choroidal neovascularization, bilateral Revise from: H44.2B3 Degenerative myopia with macular hole, bilateral eye Revise to: H44.2B3 Degenerative myopia with macular hole, bilateral Chapter 8: Diseases of the Ear and Mastoid Process ICD-10-CM Code Additions, Deletions, and Revisions

43. Revision Revise from : H44.2C3 Degenerative myopia with retinal detachment, bilateral eye Revise to: H44.2C3 Degenerative myopia with retinal detachment, bilateral Revise from: H44.2D3 Degenerative myopia with foveoschisis , bilateral eye Revise to: H44.2D3 Degenerative myopia with foveoschisis , bilateral Revise from: H44.2E3 Degenerative myopia with other maculopathy, bilateral eye Revise to: H44.2E3 Degenerative myopia with other maculopathy, bilateral Chapter 8: Diseases of the Ear and Mastoid Process ICD-10-CM Code Additions, Deletions, and Revisions

44. Additions Nasal valve collapse refers to any weakness or further narrowing of the nasal valve J34.8200 Internal nasal valve collapse, unspecified J34.8201 Internal nasal valve collapse, static J34.8202 Internal nasal valve collapse, dynamic J34.8210 External nasal valve collapse, unspecified J34.8211 External nasal valve collapse, static J34.8212 External nasal valve collapse, dynamic J34.829 Nasal valve collapse, unspecified Chapter 10: Diseases of the Respiratory System ICD-10-CM Code Additions, Deletions, and Revisions

45. Additions K60.30 Anal fistula, unspecified K60.311 Anal fistula, simple, initial K60.312 Anal fistula, simple, persistent K60.313 Anal fistula, simple, recurrent K60.319 Anal fistula, simple, unspecified K60.321 Anal fistula, complex, initial K60.322 Anal fistula, complex, persistent K60.323 Anal fistula, complex, recurrent K60.329 Anal fistula, complex, unspecified [ Deletion : K60.3 Anal fistula] Chapter 11: Diseases of the Digestive System ICD-10-CM Code Additions, Deletions, and Revisions Anal fistula- a tunnel that develops between the inside of the anus and the outside skin around the anus. Most are the result of an infection that starts in an anal gland.

46. Revision Revise from: K58.9 Irritable bowel syndrome without diarrhea Revise to: K58.9 Irritable bowel syndrome, unspecified Chapter 11: Diseases of the Digestive System ICD-10-CM Code Additions, Deletions, and Revisions

47. Additions K60.40 Rectal fistula, unspecified K60.411 Rectal fistula, simple, initial K60.412 Rectal fistula, simple, persistent K60.413 Rectal fistula, simple, recurrent K60.419 Rectal fistula, simple, unspecified K60.421 Rectal fistula, complex, initial K60.422 Rectal fistula, complex, persistent K60.423 Rectal fistula, complex, recurrent K60.429 Rectal fistula, complex, unspecified [ Deletion : K60.4 Rectal fistula] Chapter 11: Diseases of the Digestive System ICD-10-CM Code Additions, Deletions, and Revisions

48. Additions K60.50 Anorectal fistula, unspecified K60.511 Anorectal fistula, simple, initial K60.512 Anorectal fistula, simple, persistent K60.513 Anorectal fistula, simple, recurrent K60.519 Anorectal fistula, simple, unspecified K60.521 Anorectal fistula, complex, initial K60.522 Anorectal fistula, complex, persistent K60.523 Anorectal fistula, complex, recurrent K60.529 Anorectal fistula, complex, unspecified [ Deletion : K60.5 Anorectal fistula] Chapter 11: Diseases of the Digestive System ICD-10-CM Code Additions, Deletions, and Revisions

49. Chapter 12: Diseases of the Skin and Subcutaneous Tissue ICD-10-CM Code Additions, Deletions, and Revisions Additions L29.81 Cholestatic pruritus Caused by buildup of bile salts in blood causing intense itching sensation L29.89 Other pruritus [ Deletions : L29.8 Other pruritus]

50. Chapter 12: Diseases of the Skin and Subcutaneous Tissue ICD-10-CM Code Additions, Deletions, and Revisions Additions L66.10 Lichen planopilaris , unspecified Condition that causes inflammation of scalp and hair follicles L66.11 Classic lichen planopilaris Scarring that causes bald patches on the scalp L66.12 Frontal fibrosing alopecia Bald patches near hairline/forehead L66.19 Other lichen planopilaris Lassueur Graham Little Piccardi Syndrome- all of the above, plus thinning hair in armpits and groin L66.81 Central centrifugal cicatricial alopecia Progressive and chronic, causes permanent hair loss in crown of scalp L66.89 Other cicatricial alopecia [ Deletion : L66.1 Lichen planopilaris , L66.8 Other cicatricial alopecia]

51. Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue ICD-10-CM Code Additions, Deletions, and Revisions Additions Disc degeneration- medical condition that occurs when the cushioning of your spine begins to wear away M51.360 Other intervertebral disc degeneration, lumbar region with discogenic back pain only M51.361 Other intervertebral disc degeneration, lumbar region with lower extremity pain only M51.362 Other intervertebral disc degeneration, lumbar region with discogenic back pain and lower extremity pain M51.369 Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain M51.370 Other intervertebral disc degeneration, lumbosacral region with discogenic back pain only M51.371 Other intervertebral disc degeneration, lumbosacral region with lower extremity pain only M51.372 Other intervertebral disc degeneration, lumbosacral region with discogenic back pain and lower extremity pain M51.379 Other intervertebral disc degeneration, lumbosacral region without mention of lumbar back pain or lower extremity pain M62.85 Dysfunction of the multifidus muscles, lumbar region Spinal muscle impairment [ Deletions : M51.36 Other intervertebral disc degeneration, lumbar region; M51.37 Other intervertebral disc degeneration, lumbosacral region]

52. Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue ICD-10-CM Code Additions, Deletions, and Revisions Additions Inflammatory conditions affecting the tendons M65.90 Unspecified synovitis and tenosynovitis, unspecified site M65.911 Unspecified synovitis and tenosynovitis, right shoulder M65.912 Unspecified synovitis and tenosynovitis, left shoulder M65.919 Unspecified synovitis and tenosynovitis, unspecified shoulder M65.921 Unspecified synovitis and tenosynovitis, right upper arm M65.922 Unspecified synovitis and tenosynovitis, left upper arm M65.929 Unspecified synovitis and tenosynovitis, unspecified upper arm M65.931 Unspecified synovitis and tenosynovitis, right forearm M65.932 Unspecified synovitis and tenosynovitis, left forearm M65.939 Unspecified synovitis and tenosynovitis, unspecified forearm M65.941 Unspecified synovitis and tenosynovitis, right hand M65.942 Unspecified synovitis and tenosynovitis, left hand M65.949 Unspecified synovitis and tenosynovitis, unspecified hand

53. Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue ICD-10-CM Code Additions, Deletions, and Revisions Additions M65.951 Unspecified synovitis and tenosynovitis, right thigh M65.952 Unspecified synovitis and tenosynovitis, left thigh M65.959 Unspecified synovitis and tenosynovitis, unspecified thigh M65.961 Unspecified synovitis and tenosynovitis, right lower leg M65.962 Unspecified synovitis and tenosynovitis, left lower leg M65.969 Unspecified synovitis and tenosynovitis, unspecified lower leg M65.971 Unspecified synovitis and tenosynovitis, right ankle and foot M65.972 Unspecified synovitis and tenosynovitis, left ankle and foot M65.979 Unspecified synovitis and tenosynovitis, unspecified ankle and foot M65.98 Unspecified synovitis and tenosynovitis, other site M65.99 Unspecified synovitis and tenosynovitis, multiple sites [ Deletion : M65.9 Synovitis and tenosynovitis, unspecified]

54. Additions Q23.81 Bicuspid aortic valve Q23.82 Congenital mitral valve cleft leaflet Q23.88 Other congenital malformations of aortic and mitral valves Q87.86 Kleefstra syndrome Rare, genetic condition causing distinct facial features, developmental delay, intellectual disability, low muscle tone, and communication difficulties. [ Deletion : Q23.8 Other congenital malformations of aortic and mitral valves] Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities ICD-10-CM Code Additions, Deletions, and Revisions

55. Revision Revise from: Q13.81 Rieger 's anomaly Revise to: Q13.81 Rieger anomaly Chapter 17: Congenital Malformations, Deformations, and Chromosomal Abnormalities ICD-10-CM Code Additions, Deletions, and Revisions

56. Additions R41.85 Anosognosia Neurological condition in which patient is unaware of their neurological deficit or psychiatric condition Affects awareness of deficits involving judgement, emotions, memory, executive function, language skills, or motor ability Common in people with Alzheimer’s disease, dementia, bipolar disorder, and schizophrenia Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified ICD-10-CM Code Additions, Deletions, and Revisions

57. Additions Immune checkpoint inhibitors- type of immunotherapy Immunostimulant drugs- increase immune system’s ability to fight infection T45.AX1A Poisoning by immune checkpoint inhibitors and immunostimulant drugs, accidental (unintentional), initial encounter T45.AX1D Poisoning by immune checkpoint inhibitors and immunostimulant drugs, accidental (unintentional), subsequent encounter T45.AX1S Poisoning by immune checkpoint inhibitors and immunostimulant drugs, accidental (unintentional), sequela T45.AX2A Poisoning by immune checkpoint inhibitors and immunostimulant drugs, intentional self-harm, initial encounter T45.AX2D Poisoning by immune checkpoint inhibitors and immunostimulant drugs, intentional self-harm, subsequent encounter T45.AX2S Poisoning by immune checkpoint inhibitors and immunostimulant drugs, intentional self-harm, sequela Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes ICD-10-CM Code Additions, Deletions, and Revisions

58. Additions T45.AX3A Poisoning by immune checkpoint inhibitors and immunostimulant drugs, assault, initial encounter T45.AX3D Poisoning by immune checkpoint inhibitors and immunostimulant drugs, assault, subsequent encounter T45.AX3S Poisoning by immune checkpoint inhibitors and immunostimulant drugs, assault, sequela T45.AX4A Poisoning by immune checkpoint inhibitors and immunostimulant drugs, undetermined, initial encounter T45.AX4D Poisoning by immune checkpoint inhibitors and immunostimulant drugs, undetermined, subsequent encounter T45.AX4S Poisoning by immune checkpoint inhibitors and immunostimulant drugs, undetermined, sequela Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes ICD-10-CM Code Additions, Deletions, and Revisions

59. Additions T45.AX5A Adverse effect of immune checkpoint inhibitors and immunostimulant drugs, initial encounter T45.AX5D Adverse effect of immune checkpoint inhibitors and immunostimulant drugs, subsequent encounter T45.AX5S Adverse effect of immune checkpoint inhibitors and immunostimulant drugs, sequela T45.AX6A Underdosing of immune checkpoint inhibitors and immunostimulant drugs, initial encounter T45.AX6D Underdosing of immune checkpoint inhibitors and immunostimulant drugs, subsequent encounter T45.AX6S Underdosing of immune checkpoint inhibitors and immunostimulant drugs, sequela Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes ICD-10-CM Code Additions, Deletions, and Revisions

60. Additions T81.320A Disruption or dehiscence of gastrointestinal tract anastomosis, repair, or closure, initial encounter T81.320D Disruption or dehiscence of gastrointestinal tract anastomosis, repair, or closure, subsequent encounter T81.320S Disruption or dehiscence of gastrointestinal tract anastomosis, repair, or closure, sequela T81.321A Disruption or dehiscence of closure of internal operation (surgical) wound of abdominal wall muscle or fascia, initial encounter T81.321D Disruption or dehiscence of closure of internal operation (surgical) wound of abdominal wall muscle or fascia, subsequent encounter T81.321S Disruption or dehiscence of closure of internal operation (surgical) wound of abdominal wall muscle or fascia, sequela T81.328A Disruption or dehiscence of closure of other specified internal operation (surgical) wound, initial encounter T81.328D Disruption or dehiscence of closure of other specified internal operation (surgical) wound, subsequent encounter T81.328S Disruption or dehiscence of closure of other specified internal operation (surgical) wound, sequela T81.329A Deep disruption or dehiscence of operation wound, unspecified, initial encounter T81.329D Deep disruption or dehiscence of operation wound, unspecified, subsequent encounter T81.329S Deep disruption or dehiscence of operation wound, unspecified, sequela Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes ICD-10-CM Code Additions, Deletions, and Revisions

61. [ Deletions : T81.32XA Disruption of internal operation (surgical) wound, not elsewhere classified, initial encounter T81.32XD Disruption of internal operation (surgical) wound, not elsewhere classified, subsequent encounter T81.32XS Disruption of internal operation (surgical) wound, not elsewhere classified, sequela] Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes ICD-10-CM Code Additions, Deletions, and Revisions

62. Additions Z15.1 Genetic susceptibility to epilepsy and neurodevelopmental disorders Z15.2 Genetic susceptibility to obesity Z17.21 Progesterone receptor positive status Z17.22 Progesterone receptor negative status Z17.31 Human epidermal growth factor receptor 2 positive status Z17.32 Human epidermal growth factor receptor 2 negative status Z17.410 Hormone receptor positive with human epidermal growth factor receptor 2 positive status Z17.411 Hormone receptor positive with human epidermal growth factor receptor 2 negative status Z17.420 Hormone receptor negative with human epidermal growth factor receptor 2 positive status Z17.421 Hormone receptor negative with human epidermal growth factor receptor 2 negative status Z51.A Encounter for sepsis aftercare Chapter 21: Factors Influencing Health Status and Contact with Health Services ICD-10-CM Code Additions, Deletions, and Revisions

63. Additions Z59.71 Insufficient health insurance coverage Z59.72 Insufficient welfare support Z67.A1 Duffy null An antigen on the red blood cell membrane Z67.A2 Duffy a positive Z67.A3 Duffy b positive Z67.A4 Duffy a and b positive Z68.55 Body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age Z68.56 Body mass index [BMI] pediatric, greater than or equal to 140% of the 95th percentile for age [ Deletion : Z59.7 Insufficient social insurance and welfare support] Chapter 21: Factors Influencing Health Status and Contact with Health Services ICD-10-CM Code Additions, Deletions, and Revisions

64. Additions Z83.72 Family history of familial adenomatous polyposis Z86.0100 Personal history of colon polyps, unspecified Z86.0101 Personal history of adenomatous and serrated colon polyps Z86.0102 Personal history of hyperplastic colon polyps Z86.0109 Personal history of other colon polyps Z92.26 Personal history of immune checkpoint inhibitor therapy [ Deletion : Z86.010 Personal history of colonic polyps] Chapter 21: Factors Influencing Health Status and Contact with Health Services ICD-10-CM Code Additions, Deletions, and Revisions

65. Revision Revise from: Z68.54 Body mass index [BMI] pediatric, greater than or equal to 95th percentile for age Revise to: Z68.54 Body mass index [BMI] pediatric, 95th percentile for age to less than 120% of the 95th percentile for age Chapter 21: Factors Influencing Health Status and Contact with Health Services ICD-10-CM Code Additions, Deletions, and Revisions

66. ICD-10-CM Guideline Changes

67. Guideline I.C.1.d.5(b); Page 24 of ICD-10-CM FY25 Guidelines ICD-10-CM Guideline Changes

68. Guideline I.C.2.d; Page 34 of ICD-10-CM FY25 Guidelines ICD-10-CM Guideline Changes

69. Guideline I.C.2.e.2; Page 34 of ICD-10-CM FY25 Guidelines ICD-10-CM Guideline Changes

70. Guideline I.C.2.s; Page 38 of ICD-10-CM FY25 Guidelines ICD-10-CM Guideline Changes

71. Guideline I.C.2.t; Page 38 of ICD-10-CM FY25 Guidelines ICD-10-CM Guideline Changes

72. Guideline I.C.4.a.1 (a) ; Page 39 of ICD-10-CM FY25 Guidelines ICD-10-CM Guideline Changes

73. Guideline I.C.9.e.5; Page 53 of ICD-10-CM FY25 Guidelines ICD-10-CM Guideline Changes

74. Guideline I.C.21.c.3; Page 92 of ICD-10-CM FY25 Guidelines ICD-10-CM Guideline Changes

75. MS-DRG Updates

76. Concomitant Left Atrial Appendage Closure and Cardiac Ablation A new base MS-DRG was created for cases reporting a LAAC procedure and a cardiac ablation procedure: MS-DRG 317 (Concomitant Left Atrial Appendage Closure and Cardiac Ablation). MS-DRG 317 will not be subdivided into severity levels (MCC/CC) due to there not being a 20% difference in average cost between severity levels. MDC 05 (Diseases and Disorders of the Circulatory System) MS-DRG Updates

77. Neuromodulation Device Implant for Heart Failure ( Barostim™Baroreflex Activation Therapy) Reassigned all cases with one of the following ICD-10-PCS code combinations capturing cases reporting procedure codes describing the implantation of a BAROSTIM TM system, to MS-DRG 276, even if there is no MCC reported: 0JH60MZ (Insertion of stimulator generator into chest subcutaneous tissue and fascia, open approach) in combination with 03HK3MZ (Insertion of stimulator lead into right internal carotid artery, percutaneous approach); and 0JH60MZ (Insertion of stimulator generator into chest subcutaneous tissue and fascia, open approach) in combination with 03HL3MZ (Insertion of stimulator lead into left internal carotid artery, percutaneous approach). Changed the title of MS-DRG 276 from “Cardiac Defibrillator Implant with MCC” to “Cardiac Defibrillator Implant with MCC or Carotid Sinus Neurostimulator” to reflect the proposed modifications to MS-DRG assignments. MDC 05- (Diseases and Disorders of the Circulatory System) MS-DRG Updates

78. Excision of Intestinal Body Parts Reassigned procedure codes 0DB83ZZ, 0DBA3ZZ, 0DBA4ZZ, 0DBB3ZZ, 0DBB4ZZ, 0DBC0ZZ, 0DBC3ZZ, and 0DBC4ZZ from MS-DRGs 347, 348, and 349 (Anal and Stomal Procedures with MCC, with CC, and without CC/MCC) to MS-DRGs 329, 330, and 331 (Major Small and Large Bowel Procedures with MCC, with CC, and without CC/MCC). MDC 06 (Diseases and Disorders of the Digestive System) MS-DRG Updates

79. MS-DRG Logic for MS-DRGs 456, 457, and 458 Added 5 diagnosis codes describing deforming dorsopathies of specific anatomic sites -M43.8X4, M43.8X5, M43.8X6, M43.8X7, and M43.8X8 to the “OR Secondary Diagnosis” logic list for MS-DRGs 456, 457, and 458. Interbody Spinal Fusion Procedures Deleted MS-DRGs 453, 454, and 455 and created 8 new MS-DRGs. New MS-DRGs are as follows: MS-DRG 426 (Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with MCC), MS-DRG 427 (Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical with CC), MS-DRG 428 (Multiple Level Combined Anterior and Posterior Spinal Fusion Except Cervical without CC/MCC), MS-DRG 402 (Single Level Combined Anterior and Posterior Spinal Fusion Except Cervical), MS-DRG 429 (Combined Anterior and Posterior Cervical Spinal Fusion with MCC), MS-DRG 430 (Combined Anterior and Posterior Cervical Spinal Fusion without MCC), MS-DRG 447 (Multiple Level Spinal Fusion Except Cervical with MCC) and MS-DRG 448 (Multiple Level Spinal Fusion Except Cervical without MCC). Revised the title for MS-DRGs 459 and 460 to “Single Level Spinal Fusion Except Cervical with MCC and without MCC.” Revised the title for MS-DRGs 459 and 460 to “Single Level Spinal Fusion Except Cervical with MCC and without MCC.” MDC 08 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) MS-DRG Updates

80. Resection of Right Large Intestine Added procedure codes 0DTF0ZZ (Resection of right large intestine, open approach) and 0DTF4ZZ (Resection of right large intestine, percutaneous endoscopic approach) to MDC 10 in MS-DRGs 628, 629, and 630. MDC 10 (Endocrine, Nutritional and Metabolic Diseases and Disorders) MS-DRG Updates

81. MS-DRG 795 Normal Newborn Reassigned ICD-10-CM diagnosis codes Q81.0, Q81.1, Q81.2, Q81.8, and Q81.9 from MS-DRGs 606 and 607 in MDC 09 (Diseases and Disorders of the Skin, Subcutaneous Tissue and Breast) and MS-DRG 795 (Normal Newborn) in MDC 15 to MS-DRGs 595 and 596 in MDC 09 and MS-DRG 794 in MDC 15. MDC 15 (Newborns and Other Neonates with Conditions Originating in Perinatal Period) MS-DRG Updates

82. Acute Leukemia Created a new base surgical MS-DRG for cases reporting a principal diagnosis describing a type of acute leukemia with an ICD-10-PCS procedure code designated as O.R. procedure that is not listed in the logic list of MS-DRGs 820, 821, and 822. The new MS-DRG is 850 (Acute Leukemia with Other Procedures). Added the 27 ICD-10-CM diagnosis codes describing various types of acute leukemias currently listed in the logic list entitled “Principal Diagnosis” in MS-DRGs 834, 835, and 836 as well as ICD-10-CM codes C94.20, C94.21, C94.22, C94.40, C94.41, and C94.42 to new MS-DRG 850. Added the procedure codes from current MS-DRGs 823, 824, and 825 (Lymphoma and Non-Acute Leukemia with Other Procedures with MCC, with CC, and without CC/MCC, respectively) to the new MS-DRG 850 There are 189 procedure codes describing stereotactic radiosurgery of various body parts that are designated as non-O.R. procedures affecting the above MS-DRGs, therefore, as part of the logic for new MS-DRG 850, these 189 codes were assigned as non-O.R. procedures affecting the MS-DRG. Revised the titles for MS-DRGs 834, 835, and 836 by deleting the reference to “Major O.R. Procedures” in the title. Specifically, revised the titles of medical MS-DRGs 834, 835, and 836 from “Acute Leukemia without Major O.R. Procedures with MCC, with CC, and without CC/MCC”, respectively to “Acute Leukemia with MCC, with CC, and without CC/MCC.” MDC 17 (Myeloproliferative Diseases and Disorders, Poorly Differentiated Neoplasms) MS-DRG Updates

83. Laparoscopic Biopsy of Intestinal Body Parts Added procedure codes 0DBF4ZX, 0DBG4ZX, 0DBL4ZX, 0DBM4ZX and 0DBN4ZX to the FY 2025 ICD-10 MS-DRG Version 42 Definitions Manual in Appendix E—Operating Room Procedures and Procedure Code/MS-DRG Index as O.R. procedures. Laparoscopic Biopsy of Gallbladder and Pancreas Added procedure code 0FB44ZX to the FY 2025 ICD-10 MS-DRG Version 42 Definitions Manual in Appendix E—Operating Room Procedures and Procedure Code/MS-DRG Index as an O.R. procedure. Added procedure code 0FBG4ZX to the FY 2025 ICD-10 MS-DRG Version 42 Definitions Manual in Appendix E—Operating Room Procedures and Procedure Code/MS-DRG Index as an O.R. procedure. Non-O.R. Procedures to O.R. Procedures MS-DRG Updates

84. Resources Anal fistula. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/anal-fistula/symptoms-causes/syc-20352871#:~:text=An%20anal%20fistula%20%E2%80%94%20also%20called Carcinoid Syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions FAQ Eating Disorders. Johns Hopkins. https://www.hopkinsmedicine.org/psychiatry/specialty-areas/eating-disorders/faq#:~:text=The%20main%20difference%20between%20diagnoses,at%20normal%20weight%20or%20above . FY 2025 Code Updates: CM & PCS. Libman Education. https://libmaneducation.com/ FY 2025 IPPS Final Rule Home Page. CMS. https://www.cms.gov/medicare/payment/prospective-payment-systems/acute-inpatient-pps/fy-2025-ipps-final-rule-home-page Hospital Inpatient Prospective Payment System (IPPS) Final Rule for FY 2025. Federal Register. https://www.federalregister.gov/documents/2024/05/02/2024-07567/medicare-and-medicaid-programs-and-the-childrens-health-insurance-program-hospital-inpatient ICD-10-CM Official Guidelines for Coding and Reporting FY 2025. CMS. https://www.cms.gov/files/document/fy-2025-icd-10-cm-coding-guidelines.pdf /symptoms-causes/syc-20370666

85. Q&A Document can be found on Healthcatalyst.com under Resources/Webinars