The Centers for Medicare and Medicaid Services (CMS) has released the 2025 ICD-10-CM updates, which take effect on October 1, 2024. With 252 new codes, 36 deletions, and 13 revisions, it is crucial for Home Health agencies to stay updated with the changes to avoid coding errors that could affect reimbursement. Accurate documentation of primary diagnoses and corresponding provider progress notes is vital for ensuring seamless claim submissions, particularly for Pre-Claim Review episodes of care.
We’ve identified some key updates that will affect home health coding, which agencies should be aware of:
- Diabetes and Hypoglycemia: New codes are introduced for pre-symptomatic Type 1 diabetes (e.g., E10.A1 and E10.A2), which could aid in early detection and monitoring. Additionally, codes for various levels of hypoglycemia (E16.A1-A3) help better track patient care and risks associated with fluctuating glucose levels.
- Neoplasm Codes: 63 new codes are added to expand classifications and document remission statuses for cancers and lymphomas. For example, C84.7B (Anaplastic large cell lymphoma in remission) and C81.0A (Nodular lymphocyte-predominant Hodgkin lymphoma in remission).
- Expansion in the musculoskeletal and connective tissue codes: Two codes for lumbar (M51.36) and lumbosacral (M51.37) disc degeneration will be replaced by seven new codes, based on the presence of discogenic or lower extremity pain, or no mention of pain.
- Increased Specificity for Synovitis and Tenosynovitis: The category M65.- now includes expanded codes for synovitis and tenosynovitis that specify the exact body part affected (e.g., M65.911 for the right shoulder).
- Aftercare Codes: Codes like Z51.A, which track aftercare for sepsis, will help document ongoing treatment and recovery needs, making it easier for home health agencies to report on services aimed at reducing the risk of recurrent infections and other complications.
- Social Determinant of Health (SDoH) codes: Z59.7 (Insufficient social insurance and welfare support) will be split into two codes that describe either insufficient social insurance (Z59.71) or insufficient welfare support (Z59.72)
Preparing for Compliance
Home health coders need to be well-versed in the 2025 ICD-10-CM updates to accurately apply changes in clinical grouping and comorbidities and to avoid inactive codes for accurate billing and reporting.
Aside from coders, intake staff must also be aware of relevant updates to ensure they gather the correct documentation and verify the required details based on the new coding requirements.
Access the resources released by CMS containing information on the ICD-10-CM updates for FY 2025. This includes the 2025 Conversion Table which identifies ICD-10-CM codes that are inactive as of October 1, 2024, and their replacement codes.
