Pediatric Coding Alert

See how obesity coding is getting more precise.

With more than 250 new diagnosis codes, the 2025 ICD-10-CM code set affects almost every category. On Oct. 1, 2024, the Centers for Medicare & Medicaid Services (CMS) will update the code set, and pediatric coders will want to take note as multiple additions and revisions will alter your code selections during evaluation and management (E/M) visits.

Find out what changes pediatric coders should prepare for in FY 2025.

Boost Your BMI and Obesity Code Knowledge

The 2025 ICD-10-CM code set features new codes tied to the different obesity classes. For adult diagnoses, coders should assign the following codes from the E66.8- (Other obesity) code subcategory depending on the obesity class diagnosis:

• E66.811 (Obesity, class 1)
• E66.812 (Obesity, class 2)
• E66.813 (Obesity, class 3)

Class 1 obesity is for a body mass index (BMI) range of 30 to 34.9, class 2 obesity covers the 35 to 39.9 BMI range, and class 3 obesity is for a BMI of 40 or more. Keep these classes in mind as we move on to the changes to the pediatric BMI coding.

As you know, while a child may be obese, the standard BMI scale may be inaccurate to evaluate the child’s weight. While “severe obesity” in children and teens could only be captured by

Z68.54 (Body mass index [BMI] pediatric, greater than or equal to 95th percentile for age), the American Academy of Pediatrics prefers to use an expanded definition of “severe obesity” that mimics the three adult obesity classes to better represent the problem.

The 2025 ICD-10-CM code set features a revision and new codes related to pediatric BMI numbers. Effective October 1, Z68.54’s descriptor contains greater detail regarding the BMI of a pediatric patient. Compare the Z68.54 descriptors below between the 2024 and 2025 code sets:

• 2024: Body mass index [BMI] pediatric, greater than or equal to 95th percentile for age
• 2025: Body mass index [BMI] pediatric, 95th percentile for age to less than 120% of the 95th percentile for age

“The 2024 Z68.54 descriptor is considered ‘obesity,’ while the 2025 descriptor is similar to ‘severe obesity’ or class 1 obesity,” says Carol Pohlig, BSN, RN, CPC, manager of coding and education in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia.

At the same time, the 2025 ICD-10-CM code set adds more pediatric BMI codes that providers may document during evaluation and management (E/M) visits:

• Z68.55 (Body mass index [BMI] pediatric, 120% of the 95th percentile for age to less than 140% of the 95th percentile for age)
• Z68.56 (Body mass index [BMI] pediatric, greater than or equal to 140% of the 95th percentile for age)

Code Z68.55 is similar to class 2 obesity and Z68.56 is similar to class 3 obesity, according to Pohlig.

Remember: Even though an 18-year-old is legally considered an adult, the Body Mass Index (BMI) (Z68) section of the ICD-10 explains that BMI adult codes are for patients 20 years of age or older and BMI pediatric codes are for patients ages 2 to 19.

Eating Disorder Diagnosis Codes Get More Specific

There are also a number of additions to the 2025 ICD-10 code set that affect how you report certain codes from chapter 5: Mental and Behavioral Disorders. 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, you will now have 5th character options identical to those listed for F50.01. Here’s a look at how each code breaks down. Note that these descriptions are general. Physician discretion determines whether a case as mild, moderate, severe, or extreme:

• 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.

Mike Shaughnessy, BA, CPC, Development Editor, AAPC and Chris Boucher, MS, CPC, Senior Development Editor, AAPC