Sounds good. Hello, everyone. Welcome to today's webinar. I'm glad to be here today. I want to talk about the ICD-10-CM updates for 2025. And there were only three deletions and just a handful of revisions. Otherwise, it's all changes. And it's addition of codes as far as the changes go. So I'm going to be going through those changes or added codes. One concept I want to explain is a parent code turning into a expanded group of more specific codes. And this is how new codes are usually added, where a parent code is a code that was valid before October 1, which now is invalid because they've expanded that range of codes to make codes more specific. And you'll see what I'll point it out, and you'll see most of them are that way. So why I say that is because it's really important that you somehow, if possible, in your practice management system and EHR delete those old codes or inactivate them so that you don't continue to use them. Because when you send them in on a claim form with a date of service after October 1, it's going to be denied because of the diagnosis code. So you want to save time and not have claims being rejected and denied because of invalid diagnosis codes. And some of you may be able to catch those depending on your practice management system before they go out, but not all practice management systems do that. So it's best to make sure that you have all the correct ICD-10 codes. So let's go ahead and get started. This got some housekeeping here. The webinar recording, if you haven't taken a pretest, go ahead and now do that. If you want to ask a question, send it to physicianservicesatosteopathic.org with the subject listed, and they will get those to me. And then there's also the slides available. And to obtain the CME credit, you must take the post-test and evaluation. And that information's there. This is the disclaimer. And this is me. My name is Lynn Andren. I'm not going to go through my whole bio. But I've been doing this for about 42 years now. I've been in physician billing and coding. So that's my experience. That's another disclosure. I have nothing to disclose. OK. Here are the neoplasm changes. And they have gone ahead and expanded the Hodgkin's lymphoma section. And you can see that there are a lot of different kinds, as we know. These codes are all in remission, if you notice that. Now, just to give you the ICD-10 background on when somebody is considered in remission, it kind of changed from ICD-9 to ICD-10. And the fact that in ICD-9, we never had a definitive guideline as to when do we start using history of. And so we begin to use the history of codes when the patient has completed their treatment or anything that it was malignant was removed and there's no additional treatment. So I believe that you're going to bill both if you're seeing the patient for their Hodgkin's in remission, you're going to go ahead and use these codes. If you are a provider that is not treating that patient for Hodgkin's, but you want to document that the patient has a personal history of Hodgkin's, then you're going to go ahead and use that personal history code rather than the in remission codes. I have my slides, they are all the diagnosis codes themselves. And the reason why I do this is so that you have them for reference when you get back. I received my ICD-10 book for 2025 on Saturday and I can barely lift it, it's so heavy. So this makes it easier for you to find the codes because I've given you the codes themselves. So then you can go into the ICD-10 and look at them. Please make sure you do that and look at them in the tabular listing because the notes and guidelines for the codes are in the tabular listing in ICD-10. That's why it's so critical that you get new manuals every year because not only can the codes change, but the instructions for those codes can change also. So then I have additional codes for follicular lymphoma. And you can see that it is broken up into the different grades. These, again, are all in remission codes. And then we have the cell lymphoma. Not all of these are in remission. If you see the one code, the C83.398, that is not in remission code. Neither is the C83.390. When we're talking about neoplasms, the malignant neoplasms are usually a C code. And the benign lesions are usually a D code. And then other neoplasms in remission, and we have a group of them. As far as other lymphomas and neoplasms, I have listed their C84.AA through C88.90 as being another code range that has been added, if you want to take a look at that also. OK, so let me go back. There we go. So here are codes that have been added to type 1 diabetes. E10 represents type 1. These codes are not created in any other type of diabetes, only type 1. And they're pre-symptomatic. And we have an unspecified as well as stage 1 and 2. This is where you're seeing a parent code that has been expanded. So the parent code that used to be a valid ICD-10 code is E10.A. That is no longer a valid code, because now you have three choices. Either it's unspecified, stage 1, or stage 2. I just want to also touch on this unspecified code. The guidelines for ICD-10 tell us that if we can use a code other than unspecified, we should be doing that. And we'll talk about also other as a choice, too, when we come to one. The unspecified says is that you don't know whether it is stage 1 or stage 2. However, we have insurance companies that have put out policies that say that they're no longer going to accept codes that are unspecified. So you would have to document them as stage 1 or stage 2, in this case, if you were using these type 1 diabetes codes for pre-symptomatic patients. So it's important that you choose the appropriate diagnosis code. But also, your documentation should document or must document the stage also. So it's just not a matter of choosing the code for your billing, but it's also to make sure that your documentation matches what you are billing. And then we also have different levels of hypoglycemia. Here, they don't even give us an unspecified choice. It's level 1, 2, or 3. And again, the parent code E16.A is no longer a valid code. We also have a number of different types We also have carcinoid syndrome, and we have an expansion with carcinoid syndrome unspecified, heart syndrome, and then other carcinoid syndrome. Here's an example of an other. So and this is easy to see because it's only three codes. So unspecified is if you don't know what kind of carcinoid syndrome it is. If the patient has carcinoid heart syndrome, then you're going to use the E34.01. If the patient has some other kind of carcinoid syndrome, but it's not heart, then we're going to use the other carcinoid syndrome code, which is the E34.09. And the reason we want to use that instead of unspecified is other is not considered unspecified. So if there's an insurance company that says they're not accepting unspecifieds, they will accept the others. Because you don't have a choice there. But again, we need to be documenting and matching what our diagnosis codes are. So often I see the documentation does not go as specific as the choice of the code themselves. And then that's a problem on the coding side. Maybe we'll have to prove at some point an insurance company is doing some auditing and we would have to prove that it was a specific kind of, in this case, carcinoid syndrome. And it's not documented in the note. So the bill and the note aren't matching. OK. Here is obesity. And these are in the endocrine system. Again, we had a parent code that now has been expanded into obesity classes. The thing to know about obesity codes or really obesity, morbid obesity, those codes are related to and are reported with the BMI codes. And we did have a couple of additions to the BMI codes also. And if you look at the instructions for the obesity codes or the BMI codes, in both cases, it will tell you that you need to be billing a second code. So if you're billing BMI codes as diagnosis codes, you should also be choosing obesity codes or codes that say the patient has unexplained weight loss. So it can't just be a BMI code is basically what I'm saying. It also has to explain why are you saying that it's a BMI? What is the purpose of that? So and you see there's obesity not otherwise or elsewhere classified, the E66.89. That could be considered other also, but it also could be considered unspecified. It's kind of a because there's no other code. So the patient doesn't have class 1 through class 3 obesity. They have a different kind. Then you're going to use the other code again. We also have an expansion of anorexia nervosa. And you can see that we have mild, moderate, severe, and extreme. So there are four different levels. And then we have in remission or unspecified. And then we have the binge eating purging type of anorexia nervosa. And then they are broken up in the same choices as far as mild, moderate, severe, extreme, in remission or unspecified. And then we also have new codes for the bulimia nervosa. So just again, an expansion of the codes for eating disorders. And then this is binge eating disorder itself. So in this case, they just have a binge eating disorder. It's anorexia nervosa. All right, now we're jumping to the codes that begin with the letter G, which is the nervous system. And related to epilepsy, they are talking about the intractable versus intractable. and then with the status of epilepticus or without, and it is the KCNQ2 epilepsy. And again, we had the code G40.84, but now they've expanded into the different types. Or where the patient is at. We have embolism. Now we're into the cardiovascular system and we have pulmonary artery embolisms, whether they are cement or fat, and then with or without that core pulmonal. And in the respiratory system, we have the nasal valve collapse, and there is an internal nasal valve and an external nasal valve. And so again, we've taken these codes and expanded them to what, other than internal and external, are they static or dynamic? And then we also do have the unspecified code. Now, if in fact, it's not documented as whether it's internal or external, we have a code for that also. And that's J34.829. So we would use that if it's not documented as internal or external, we can't pick the unspecified codes in those categories. We would have to know that at least. Now we're into the digestive system and we have different kinds of fistulas. And so your unspecified anal fistula now is K60.319 instead of K60.30. So if you're sending a claim in and the date of service is after October 1st, and you sent that in with a K60.30, the claim will be denied. So just a delay in your reimbursement and somebody in your office has to fix it. So spending time to do that and you don't wanna have to do that on a claim that should be able to go through the system quite easily. And then the different kinds of simple anal fistulas. And then we also have the anal fistulas that are complex. And then those are divided the same way by initial persistent or recurrent. And then we have the unspecified option. Then we have rectal fistulas with the same divisions. And notice now that the unspecified rectal fistula has now changed. The reason why I'm pointing that out is I will tell you in my experience with the ICD-10 codes, somebody could have all four of these codes right in front of them. And they're always gonna pick the unspecified or 99% of the time. And I don't know why. If they know what it is and there's options, why do you continue to pick unspecified? So, yeah. And then we have rectal fistulas complex with the same divisions. The other thing about picking unspecified diagnosis versus specified, it really would affect if you're being paid or reimbursed based on any kind of risk adjustment. Your unspecified codes may not have a value where your specified codes may. The other thing is there are insurance carriers that have policies. All insurance carriers will have coding policies. And in those coding policies, very often they list what are the payable diagnosis. If you are picking an unspecified diagnosis and they don't consider that payable, that claim is gonna deny because they only have the specific codes listed in the policy. Even if you put a policy assigned diagnosis and another diagnosis that isn't in the policy, sometimes the computer systems at the insurance companies will spit those out because even though you had a correct one, you had an invalid one, so it automatically spit it out because of the invalid. It doesn't have a way of looking at it and saying, well, if this is there, then it doesn't matter what else is there. It will just automatically read that that bad diagnosis is there and spit the whole claim out. And then the anorectal fistula. And again, we have the simple and complex. All right, now we're in my primary specialty in the intermuscle skeletal system. And they have gone ahead and expanded M51.36 to now have a six character describing where the pain is. So we have discogenic pain or lower extremity pain or both, or no mention of any pain, either lumbar or lower extremity. So that's gonna be important too. This is gonna cause a problem for sure because we all have in our minds M51.36. So now we're gonna have to expand those. Also remember if your computer system, whichever you're using, prints previous diagnoses, you have to be careful with those too because this is an example where 51.36 could be what you have in your EHR where however you submit your coding or your codes and it's gonna automatically deny or reject because of that invalid diagnosis. I see a lot of times where the provider just says same on the diagnosis that are there from the previous visit. We should always be checking those because sometimes you're seeing the patient for a new problem. Okay, and then we have synovitis and tenosynovitis. Again, the parent code here is M65.9, which was unspecified tenosynovitis and tenosynovitis. We never had codes that were specific to the body area. So now they have divided them in body area where we have, this is the right shoulder and the left and then the upper arm. And if we go on to the other ones, we have forearm and then hand. And then we have right and left thigh and right and left lower leg. Now for ICD-10 purposes, the wrist is included in the hand and the ankle would be included in this case in the right lower leg. Oh, but the knee is going to be included in the lower leg. And I believe your ICD-10 says that in the numerical listing that that's how you should be coding them. Oh, here's ankle, sorry, there's an ankle code. It goes along with the foot. And then the other site, I guess you could have it somewhere else. Then there's a code here for multiple sites. And that can be very common where a patient will have it in multiple areas. So you can also use that M65.99. They don't do that very often in ICD-10 where they give us a multiple site code. Normally we're having to bill each site that's involved. So here they've given us that code. All right, now we're into the congenital disorders. And these are related to both the mitral valve and the aortic valve of the heart. And there are specific kinds of valve problems. The one is a bicuspid aortic valve. The other one is a congenital mitral valve cleft leaflet. If the patient does have other congenital malformations of the aortic or mitral valves and mitral valves, I'm sorry, not or, then we can use the Q23.88. When you get into the congenital codes, they're not always real specific. And there's tends to be changes to those Q codes every year where they're finding areas that need to be expanded to give further definition. So you've got that here. And then the last one is the Clefstra syndrome, the Q87.86. I added that here because it was the only other Q code that was changing or being added. So I just added it to the bottom of this slide. It is not a necessary, it's not a congenital disorder. Just wanna explain that. Okay, so when we are in ICD-10 and we're talking about prescription medication and the different ways that it can be taken, we consider anything where the patient is having a reaction to the drug or substance as a poisoning. And then we have the different elements of poisoning that explain what exactly happened. And also these codes do get a A, D, or S seventh character. And just to give you a review of what the seventh characters mean, the A means that the patient is receiving active treatment. Now it can be your initial visit with that patient, or it could be as long as you are treating the patient, it will continue to be an A. Once the patient has gotten better, but you're still following up with them, then it would turn to a D as the seventh character. And then finally, if a patient ends up with a quote unquote side effect or late effect of a substance or chemical or drug, then it will be an S code. And whatever their primary problem is related to that use of that drug, that would be your initial diagnosis followed by this code with the S. So these codes would follow the patient. Anytime you would see the patient for the rest of their lives, you would relate it to this, you would bill this code with an A, D, or S. So now just going through what the different kinds of poisoning there are. The first one is accidental or unintentional. And what they consider accidental or unintentional is when the patient has taken someone else's medication by mistake. So my husband and I have pill bottles all over the table, and I grabbed the wrong pill bottle and take a medication out of there. The intentional self-harm I think is self-explanatory. The assault is when the patient was forced to take that substance or drug. In these cases of these codes, these are all inhibitors or immunostimulant drugs. But we have codes like this for practically every drug or substance. And then the undetermined, obviously where this is most popular or most commonly used is in the emergency room, patient comes through unconscious, but we're not sure how this patient got this medication in the first place. And the patient is unconscious, so there's no way of being told unless somebody was there to know. And then again, these are the initial encounter. Adverse effect, that is when the patient was prescribed the medication and has an allergic reaction. And then underdosing, which can be a big problem, is when mostly used when a patient has financial difficulty paying for the prescription drug. And so they decide to cut down their prescription dosage so that it goes further, right? So I'm gonna take a 200 milligram pill and cut it in half and I'm supposed to take 200 milligrams but I'm only gonna take 100 milligrams because then I have it for today and tomorrow. Unfortunately, and we know that sometimes that doesn't work well because that's not how the medication is, the dosage is, right? So that can become important. Also very often when a patient is underdosing there is a social determinant of health that is related to it. And we're gonna talk about a couple additions to that area also here in just a minute. So, and that there is a continued expansion of the social determinants of health. And there are insurance companies that are requiring those codes also for certain procedures and services. All right, these codes are for a problem of different kinds of disruption or deficits of post-operative wounds. So we have the gastrointestinal tract anastomosis disruption or dehiscence. We have the internal operation wound of the abdominal wall muscle or fascia. And then we also have the disruption or dehiscence of a closure of an internal operation wound or just the unspecified operative wound that has a deep disruption or dehiscence. Again, as you notice, these all take either A, D or S. And I'm showing that by those parentheses after the code with A through S in there. And we do have other seventh characters in this particular chapter 19 of the ICD-10 but not all of the codes are valid with all of those seventh characters. So I'm giving you the specific ones here. Depending on what kind of ICD-10 book you're using, they do normally alert you to the valid seventh characters in some way, shape or form. I do see it differently in how it's done from one book to another. If there has been different publishers that is not required really. And the book, the ICD-10 book is not copyrighted. It is managed by World Health Organization and Medicare. However, it's not copyrighted. So different publishers will have their own version of the ICD-10-CM where the codes are all the same and the initial instructions are the same. However, they add different things to different kinds of symbols and different ways of showing certain things. And so that is part of the numerical system that is done. And however, the publishing company wants to do it. So here are Z codes. And Z codes are normally codes that we use when the patient doesn't necessarily have a problem. They are coming in for a routine exam or they're coming in for a screening of some kind and their insurance company is gonna, if they have the coverage where preventative medicine's paid at 100%, those kinds of things. And so you can see here that these all have to do with different kinds of either conditions. So you can see the first ones are genetics, suspectability to epilepsy and neurodevelopmental disorders, and then genetic suspectability to obesity. Then there are two codes for progesterone receptor, whether it's negative or positive. And then also the human epidermal growth factor receptor, is it positive or negative? And that's receptor two, sorry about that. So these are all codes that are just stating that the patient has had some kind of testing that shows that they have this suspectability or they have a, you know, or what kind of progesterone receptor or human epidural growth factor receptor two do they have. Then we also have the hormone receptor positive with human epidural growth factor receptor two with positive and negative receptor. And so we have positive with negative and positive, and then negative hormone receptor with positive and negative epidural growth factor receptor two. I think you can see what I'm saying there. Four choices. And then we have here are a couple of the social determinative health Z codes. So we have encounter for sepsis after care. Again, you know, they no longer have sepsis, but you're still seeing them in follow-up. So you would use this code. We have to get better at choosing these kinds of codes when the patient has been, is no longer caring or has that condition. Now we can show that by a seventh character in some circumstances when there is a seventh character option. However, there's Z codes for this different kinds of aftercare also. So, you know, a patient that no longer has sepsis, we don't want to continue billing them with sepsis. They don't have it anymore. And so, but we want to let them know that we're seeing them for aftercare for that, which is still, but the patient doesn't have the sepsis. And then here's the two social determinants of health codes, the Z59.71 and the Z59.72. One is insufficient healthcare coverage and the other one is insufficient welfare support. Then we have Z codes for Duffy. And we have, as you can see, there are five different options here. And here are the two BMI codes that have been added. Up until now, as far as the BMI codes, the official instructions for the BMI codes say the patient has to be 18 years or older and we're not using BMI codes for anybody under the age of 18. So now we're adding two pediatric BMI codes. As you can notice, they're very specific to pediatric. And then they're using the 95th percentile, which is a very common thing, as we all know in pediatrics. And then there is a family history code down there for polyposis. For personal history, again, when a patient has a malignancy that has been treated in total by excision or the treatment has been completed, that's when we start using a personal history code. And so again, if you excise the malignancy and there's no longer any malignancy left, we're gonna consider that a history of, and they no longer have it versus continuing to bill them with a malignancy. So these are the different kinds. And most of them are related to what kind of polyps, colon polyps has the patient had. And then there's one other one down there. Again, I just added it to the bottom of the slide. Personal history of immune checkpoint inhibitor therapy. These are the three codes that were deleted. So these codes have been deleted because now we have disruption and dehiscence added. And the codes have actually changed a little bit. This is only, and it's really only one code that's been deleted. It's just, they always show it as how each code with the seven characters counted as one. So you can see that all three of these codes are the same except for the seventh character. So they've added the dehiscence and they've really expanded this whole idea of a problem with the surgical wound to have more options. There were a couple guidelines changed. So there are actually four different places in ICD-10 where you can find guidelines for codes. Again, depending on where your publisher puts it, my particular ICD-10 manual has the official guidelines and conventions by chapter at the beginning of the ICD-10 book. Some of them put it at the end, but it's required to be part of the ICD-10. And that's the first place we can follow guidelines. The next place we can follow guidelines is at the beginning of each chapter in the numerical section, they can have guidelines. For example, in the OB-GYN chapter of ICD-10, it says that all codes, OB-GYN chapter is actually, it's just actually OB. Well, it could be GYN-2, because we can build it as long as a patient's being treated for complication due to pregnancy. It says at the beginning of that chapter that all codes need to have a weeks of gestation code also with the O code. And then there are codes that also are divided by trimester and they define the ICD-10 definition of trimester. That's at the beginning of that chapter. So it involves all of the O codes. Then you can find a guideline underneath the three character category of a code that would involve any code underneath it that's indented. And then there are sometimes guidelines under the code itself when it only affects that particular code. So there are many different places to find guidelines, but we also have those official guidelines. And so I went and in those official guidelines, they bold anything that's changed, makes it really nice to find them instead of having to compare. This is a lot of pages, and it would be very difficult to try to find the changes sometimes. Because in this case, they had to change this particular section, chapter 11, which just happens to be the O section. Because of the change in the surgical wound infections, they had to go ahead and change this guideline to say that you need to use a T81.49 code in order to bill an infection of an obstetric surgical wound and other surgic site. You need to also bill the infection. And again, the infection should be first if you know what it is. Sometimes you don't know what it is yet. And then in the breast implant associated anaplastic large shell lymphoma, they had to go in here and change one of the codes due to the Hodgkin's lymphoma changes. It affected this particular section. So those were the only two major changes in the guidelines, which is very surprising because usually there's a lot more than that. So we had a fortunate year here. I don't know about CPT yet. Okay, here are some AOA resources. And you can always go to them and you can send your questions. And I believe, again, I think it is the Physician Services, a email address for any questions that you may have that I can answer for you after today. Thank you for attending today. And there is a note here also about obtaining your CME credit. Thank you for listening.

ICD-10-CM updates

code revisions

practice management systems

Hodgkin’s lymphoma

type 1 diabetes

postoperative complications

social determinants of health

AOA resources