IC D 10 - CM UPDATES FOR 2025
DOROTHY D. STEED
MSLD, CCS, CDIP, COC, CPCO, CPUM, CPUR, CPHM, CPMA, ACS-OP, CCS-P, RCC, RMC, CEMC, CPC-I, CFPC, PCS, FCS, CRCR, CICA, CPAR
GUIDELINES UPDATES
• Sepsis due to a postprocedural infection For sepsis following a postprocedural wound (surgical site) infection, a code from T81.41 to T81.43, Infection following a procedure, T81.49, Infection following a procedure, other surgical site, or a code from O86.00 to O86.03, Infection of obstetric surgical wound, or code O86.09, Infection of obstetric surgical wound, other surgical site, that identifies the site of the infection should be sequenced first, if known. Assign an additional code for sepsis following a procedure (T81.44) or sepsis following an obstetrical procedure (O86.04). Use an additional code to identify the infectious agent. If the patient has severe sepsis, the appropriate code from subcategory R65.2 should also be assigned with the additional code(s) for any acute organ dysfunction.
• If a patient admission/encounter is chiefly for the administration of chemotherapy, immunotherapy or external beam radiation therapy assign code Z51.0, Encounter for antineoplastic radiation therapy, or Z51.11, Encounter for antineoplastic chemotherapy, or Z51.12, Encounter for antineoplastic immunotherapy as the first-listed or principal diagnosis.
NEOPLASMS CHAPTER 2
• Hodgkin Lymphomas: C81x – C84x
• There are multiple code clarifications that add “in remission” or “not having achieved remission”
• Non-Hodgkin Lymphomas: C85x – C86x
• There are multiple code clarifications that add “in remission” or “not having achieved remission”
• C88 Malignant immunoproliferative diseases and certain other B-cell lymphomas
• There are multiple code clarifications that add “not having achieved remission”
DISEASES OF BLOOD & BLOODFORMING ORGANS & IMMUNE MECHANISMS CHAPTER 3
• D61 Other aplastic anemias and other bone marrow failure syndromes
• D61.03 Fanconi anemia
• D89.83 Cytokine release syndrome
• Use Additional code for adverse effect, if applicable, to identify immune checkpoint inhibitors and immunostimulant drugs (T45.AX5)
ENDOCRINE, NUTRITIONAL & METABOLIC DISEASES CHAPTER 4
• E08 & E09 Diabetes mellitus due to underlying condition
• E10.A Type 1 diabetes mellitus, presymptomatic
• Additional descriptors:
• Early-stage type 1 diabetes mellitus
• E10.A0 Type 1 diabetes mellitus, presymptomatic, unspecified
• E10.A1 Type 1 diabetes mellitus, presymptomatic, Stage 1
• Multiple confirmed islet autoantibodies with normoglycemia
• E10.A2 Type 1 diabetes mellitus, presymptomatic, Stage 2
• Confirmed islet autoimmunity with dysglycemia
MENTAL, BEHAVIORAL AND
NEURODEVELOPMENTAL DISORDERS
CHAPTER 5
• F50.020 Anorexia nervosa, binge eating/purging type, mild
• Anorexia nervosa, binge eating/purging type, with a body mass index greater than or equal to 17 kg/m2
• F50.021 Anorexia nervosa, binge eating/purging type, moderate
• Anorexia nervosa, binge eating/purging type, with a body mass index of 16.0-16.99 kg/m2
• F50.022 Anorexia nervosa, binge eating/purging type, severe
• Anorexia nervosa, binge eating/purging type, with a body mass index of 15.0-15.99 kg/m2
• F50.023 Anorexia nervosa, binge eating/purging type, extreme
• Anorexia nervosa, binge eating/purging type, with a body mass index of less than 15.0 kg/m2
• F50.024 Anorexia nervosa, binge eating/purging type, in remission
• Anorexia nervosa, binge eating/purging type, in full remission
• Anorexia nervosa, binge eating/purging type, in partial remission
• F50.029 Anorexia nervosa, binge eating/purging type, unspecified
DISEASES OF THE NERVOUS
SYSTEM CHAPTER 6
• G40.8 Other epilepsy and recurrent seizures
• G40.84 KCNQ2-related epilepsy
• G40.841 KCNQ2-related epilepsy, not intractable, with status epilepticus
• G40.842 KCNQ2-related epilepsy, not intractable, without status epilepticus
• KCNQ2-related epilepsy NOS
• G40.843 KCNQ2-related epilepsy, intractable, with status epilepticus
• G40.844 KCNQ2-related epilepsy, intractable, without status epilepticus
DISEASES OF THE CIRCULATORY SYSTEM CHAPTER 9
• I16.1 Hypertensive emergency
• Use Additional code, if applicable, to identify specific organ dysfunction, such as:
• acute kidney injury (N17.-)
• acute myocardial infarction (I21.-)
• acute pulmonary edema (left and/or right ventricular failure) (J81.0, I50.-)
• aortic dissection (I71.0-)
• cerebral hemorrhage (I60.-. I61.-, I62.-)
• cerebral infarction (I63.-)Add eclampsia (O15.-)
• hypertensive encephalopathy (I67.4)
• seizure (R56.9)
DISEASES OF THE RESPIRATORY
SYSTEM CHAPTER 10
• J34.82 Nasal valve collapse
• Nasal valve compromise
• Nasal valve stenosis
• Code first underlying cause, such as:
• deviated nasal septum (J34.2)
• J34.820 Internal nasal valve collapse
• J34.8200 Internal nasal valve collapse, unspecified
• J34.8201 Internal nasal valve collapse, static
• Narrowing of the septum, head of the inferior turbinate and the upper lateral cartilage
• J34.8202 Internal nasal valve collapse, dynamic
• Collapse or falling of the upper, middle sidewall of the nose on inspiration
• J34.821 External nasal valve collapse
• J34.8210 External nasal valve collapse, unspecified Add
• J34.8211 External nasal valve collapse, static
• Fixed narrowing of the caudal septum, lower lateral cartilage, alar rim and nasal sill
• J34.8212 External nasal valve collapse, dynamic
• Collapse or falling of the lower sidewall or nostril of the nose on inspiration
• J34.829 Nasal valve collapse, unspecified
DISEASES OF THE DIGESTIVE
SYSTEM CHAPTER 11
• K60.3 Anal fistula Add Code first, if applicable:
• Crohn's disease (K50.-)
• ulcerative colitis (K51.-)
• K60.30 Anal fistula, unspecified
• Anal fistula NOS
• K60.31 Anal fistula, simple
• Low intersphincteric anal fistula
• Superficial anal fistula
• K60.311 Anal fistula, simple, initial
• Anal fistula, simple, new
• K60.312 Anal fistula, simple, persistent
• Anal fistula, simple, chronic
• K60.313 Anal fistula, simple, recurrent
• Anal fistula simple, occurring following complete healing
• K60.319 Anal fistula, simple, unspecified
DISEASES OF THE SKIN & SUBCUTANEOUS TISSUE CHAPTER 12
• L29.8 Other pruritus
• L29.81 Cholestatic pruritus
• Code also, if applicable, type of liver disease
• Use Additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)
• L29.89 Other pruritus
• L66.10 Lichen planopilaris, unspecified
• L66.11 Classic lichen planopilaris
• Follicular lichen planus
• L66.12 Frontal fibrosing alopecia
• FFA Add L66.19 Other lichen planopilaris
• Lassueur Graham-Little Piccardi syndrome
• L66.81 Central centrifugal cicatricial alopecia
• L66.89 Other cicatricial alopecia
DISEASES OF MUSCULOSKELETAL & CONNECTIVE TISSUE CHAPTER 13
• M51.360 Other intervertebral disc degeneration, lumbar region with discogenic back pain only Other intervertebral disc degeneration, lumbar region with axial back pain only
• M51.361 Other intervertebral disc degeneration, lumbar region with lower extremity pain only Other intervertebral disc degeneration, lumbar region with leg pain only
• Other intervertebral disc degeneration, lumbar region with referred sclerotomal pain only
• M51.362 Other intervertebral disc degeneration, lumbar region with discogenic back pain and lower extremity pain
• Other intervertebral disc degeneration, lumbar region with discogenic back pain and leg pain
• Other intervertebral disc degeneration, lumbar region with axial back pain and referred sclerotomal pain
• M51.369 Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or lower extremity pain
• Other intervertebral disc degeneration, lumbar region without mention of lumbar back pain or leg pain
• Other intervertebral disc degeneration, lumbar region, NOS
CONGENITAL MALFORMATIONS,
DEFORMATIONS AND CHROMOSOMAL
ABNORMALITIES CHAPTER 17
• Q23.81 Bicuspid aortic valve Add Congenital bicuspid aortic valve
• Add Unicuspid (congenital) aortic valve (at birth)
• Add Code also, if applicable, acquired aortic valve disorders, such as:
• Add aortic (valve) insufficiency (nonrheumatic) (I35.1)
• Add aortic (valve) stenosis (nonrheumatic) (I35.0)
• Add aortic (valve) stenosis with insufficiency (nonrheumatic) (I35.2)
• Add Q23.82 Congenital mitral valve cleft leaflet
• Add Cleft mitral valve leaflet at birth
• Add Q23.88 Other congenital malformations of aortic and mitral valves
• Q87.86 Kleefstra syndrome
INJURY, POISONING AND CERTAIN
OTHER CONSEQUENCES OF EXTERNAL CAUSES CHAPTER 19
• T45.A Poisoning by, adverse effect of and underdosing of immune checkpoint inhibitors and immunostimulant drugs
• T45.AX Poisoning by, adverse effect of and underdosing of immune checkpoint inhibitors and immunostimulant drugs
• T45.AX1 Poisoning by immune checkpoint inhibitors and immunostimulant drugs, accidental (unintentional)
• Poisoning by immune checkpoint inhibitors and immunosuppressive drugs NOS
• T45.AX2 Poisoning by immune checkpoint inhibitors and immunostimulant drugs, intentional selfharm
• T45.AX3 Poisoning by immune checkpoint inhibitors and immunostimulant drugs, assault T45.AX4 Poisoning by immune checkpoint inhibitors and immunostimulant drugs, undetermined
• T45.AX5 Adverse effect of immune checkpoint inhibitors and immunostimulant drugs
• T45.AX6 Underdosing of immune checkpoint inhibitors and immunostimulant drugs
FACTORS INFLUENCING HEALTH
STATUS AND CONTACT WITH HEALTH SERVICES CHAPTER 21
• Z15.1 Genetic susceptibility to epilepsy and neurodevelopmental disorders
• Code also, if applicable, related disorders such as:
• developmental and epileptic encephalopathy (G93.45)
• developmental disorder of speech and language (F80.-)
• developmental disorders of scholastic skills (F81.-)
• epilepsy, by specific type (G40.-)
• intellectual disabilities (F70-F79)
• other neurodevelopmental disorder (F88)
• pervasive developmental disorders (F84.-)
QUESTIONS???