Effective April 1st, the April 2025 ICD-10-CM updates introduce several important changes that directly affect home health coding. Highlights include new guidance on obesity-related codes, updated documentation requirements for COVID-19, and multiple revisions to the Tabular List of Diseases and Injuries. Here’s a quick look at the key changes home health coders need to know.
Updates to COVID-19 Guidelines
- Confirmed COVID-19 Cases
A guideline under 1.C.1.g.1.a stating “Code only confirmed cases” was updated to state that confirmed cases of COVID-19 must be documented by the provider. The words “or documentation of a positive COVID-19 test result” are removed. The new guideline states:
“Code only a confirmed diagnosis of the 2019 novel coronavirus disease (COVID-19) as documented by the provider.”
2. Asymptomatic Individuals Testing Positive for COVID-19
The guideline under 1.C.1.g.1.h was also updated to state:
“For asymptomatic individuals who test positive for COVID-19 and there is no provider documentation of a diagnosis, query the provider. A false positive test is possible, and it is the provider’s responsibility to confirm the diagnosis.”
What this means for HHAs:
Previously, coders could assign the COVID-19 diagnosis code (U07.1) based solely on a positive laboratory result. However, with the updated guidelines, this practice has changed. Effective April 1, 2025, the assignment of code U07.1 requires explicit documentation from a healthcare provider confirming the diagnosis of COVID-19. This means that a positive test result alone is no longer sufficient for coding; a provider’s clinical judgment and documentation are now essential.
For home health agencies, this change underscores the importance of thorough and accurate documentation. Clinicians must ensure that any diagnosis of COVID-19 is clearly stated in the patient’s medical record to support appropriate code assignment.
Updates to Obesity Guidelines
Two new guidelines have been added to category E66 (Overweight and Obesity).
- New guideline for “Obesity” under 1.C.4.b states:
“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.”
2. New guideline for “Obesity class” under 1.C.4.b.1 states:
“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.”
Tabular List Updates: Key Changes
Coders should also review the April 2025 ICD-10-CM Tabular List of Diseases and Injuries Update, which includes revisions and clarifications.
- Spelling and Typographical Corrections
- Correction to the spelling of Pneumocystis jirovecii, which is a clarifying term for B59 (Pneumocystosis)
- An “Excludes 1” note has been added to code J17 (Pneumonia in diseases classified elsewhere).
2. New “Use Additional Code” Notes
- Coders should now report E88.A (Wasting disease due to underlying condition) alongside codes for associated cachexia in cases involving J65 (Pneumoconiosis with tuberculosis) and specific tuberculosis (A15-A19) or chronic kidney disease (N18).
3. Additional Changes
- New “Excludes 1” note has been added for postsurgical malabsorption (K91.2), applicable to code K90.82 (Short bowel syndrome).
- The word “complicated” has been removed from the Excludes2 note for Z33.2 (Encounter for elective termination of pregnancy).
- Codes related to birth trauma and obstetric trauma have been moved from “Excludes 1” to “Excludes 2” under Chapter 19.
- The 7th-character note for S06 (Intracranial injury) has been revised for clearer guidance on its use.
In addition to coders being fully up to date on these changes, it’s equally important to review the updates with your clinical team to ensure accurate documentation that supports care planning and maximizes reimbursement.
