ED Coding and Reimbursement Alert

Also, synovitis/tenosynovitis combo code expands.

ICD-10 has released its list of new, revised, and deleted codes for 2025.

Impact: Code sets have been expanded for type 1 diabetes and several eating disorders, among others. You’ll want to know the changes before they take effect on October 1. 2024, so you can hit the ground running when the new codes are released.

Here’s a look at how the changes will affect your ED.

Codes Converted to Parent

ICD-10 has introduced a whole new category of diabetes diagnosis: Beginning October 1, E10.A- (Type 1 diabetes mellitus, presymptomatic) will simultaneously be a new code and a parent code. Remember, when a code is a parent code, it is a category unto itself and has codes beneath it that are more specific (children codes, if you will).

The “children” to E10.A- will be:

• 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)

ICD-10 made similar additions to hypoglycemia and obesity diagnosis codes. Check out this rundown of the new diagnosis codes in these categories:

New code/parent: E16.A- (Hypoglycemia level)

New codes

• E16.A1 (Hypoglycemia level 1)
• E16.A2 (Hypoglycemia level 2)
• E16.A3 (Hypoglycemia level 3)

New code/parent E66.8- (Other obesity)

New codes

• E66.81- (Obesity class)
• E66.811 (Obesity, class 1)
• E66.812 (Obesity, class 2)
• E66.813 (Obesity, class 3)
• E66.89 (Other obesity not elsewhere classified)

Eating Disorder Diagnoses Also Get Parental Conversions

There are a number of additions to the 2025 ICD-10 code set that will make reporting certain conditions more specific. For starters, code F50.01 (Anorexia nervosa, restricting type), a currently existing code, will be converted to parent.

Then, ICD-10 will expand this set to include the following new codes:

• 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)
• ICD-10 2025 also converts the following already existing codes to parents:
• F50.02 (Anorexia nervosa, binge eating/purging type)
• F50.2 (Bulimia nervosa)
• F50.81 (Binge eating disorder)

Beneath each of the parent codes will be 4th character options identical to those listed for F50.01. Here’s a look at each of the 4th character options for these new codes:

• 5th character 0: Mild. This disorder grade involves occasional calorie restriction, binging, or purging, depending on the disorder. Patients with a mild grade will have symptoms, but they’re not likely to affect daily functioning.
• 5th character 1: Moderate. This disorder grade involves more regular calorie restriction, binging, or purging. This is where the disordered eating begins to interfere with the patient’s daily life; they might report that the disorder has impacted social activities, work, or school. The change in the patient’s weight or health might be evident, but it is not yet life-threatening.
• 5th character 2: Severe. This disorder grade involves persistent — sometimes compulsive — behaviors that the patient has difficulty controlling. The disordered eating for severe patients will significantly impair their daily life, along with their physical and emotional health. Patients with severe eating disorders might be suffering from severe weight changes, nutritional deficiencies, and psychological distress.
• 5th character 3: Extreme. This disorder grade is the highest, marked by extreme, intense, and, frequent disordered eating. Patients with extreme disordered eating will have life-threatening symptoms, such as dangerously low weight, organ failure, or other severe complications. A person with extreme disordered eating might even be refusing to eat almost entirely.
• 5th character 4: Use this character when the eating disorder is in remission.
• 5th character 9: Use this character when the eating disorder is unspecified.

Here’s 1 More Proud New Parent

Perhaps the most detailed conversion of a code to parent is M65.9 (Synovitis and tenosynovitis, unspecified), which will be converted to parent in October, leading to a slew of new codes.

Here’s a look at some of the new codes that will grace ICD-10 in October:

• M65.90- (Unspecified synovitis and tenosynovitis, unspecified site)
• M65.91- (Unspecified synovitis and tenosynovitis, shoulder)
• M65.92- (Unspecified synovitis and tenosynovitis, upper arm)
• M65.93- (Unspecified synovitis and tenosynovitis, forearm)
• M65.94- (Unspecified synovitis and tenosynovitis, hand)
• M65.95- (Unspecified synovitis and tenosynovitis, thigh)
• M65.96- (Unspecified synovitis and tenosynovitis, lower leg)
• M65.97- (Unspecified synovitis and tenosynovitis, ankle and foot)
• M65.98 (Unspecified synovitis and tenosynovitis, other site)
• M65.99 (Unspecified synovitis and tenosynovitis, multiple sites)

Note: The majority of these codes will require a 6th character to indicate laterality (left, right, unknown). This new code set will make reporting synovitis/tenosynovitis more specific, which should help to target patient care. Make sure to code as specifically as possible on your unspecified synovitis/ tenosynovitis claims with these new codes.

Chris Boucher, MS, CPC, Senior Development Editor, AAPC