April 2025 Coding Changes

The Centers for Disease Prevention and Control (CDC) posted the updated ICD-10-CM code files to address revisions to the ICD-10-CM Official Guidelines for Coding and Reporting and other typographical errors. These updates are effective April 1, 2025.

The CDC has announced there are no new ICD-10-CM codes effective April 1, but there is a significant update to the guidelines for coding COVID-19. The guidelines are a set of rules that have been developed to accompany and complement the official conventions and instructions provided within the ICD-10-CM itself. Adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA).

The following changes are noted in the guidelines for coding confirmed cases of COVID-19, effective April 1, 2025: 

• Code only a confirmed diagnosis of the COVID-19 (U07.1) as documented by the provider (physician or other qualified health care practitioner legally accountable for establishing the patient’s diagnosis). The guidance that documentation of a positive test is a confirmed diagnosis is in effect as of April 1.
• For asymptomatic residents who test positive for COVID-19, query the medical provider as to whether the resident has COVID-19. The guidance notes that false positives are possible, and it is the medical provider’s responsibility to confirm and document a diagnosis.

This will result in a significant change in which residents will have the code U07.1 added to their medical records beginning April 1. These changes, however, do not impact on National Healthcare Safety Network (NHSN) reporting at this time. We will continue to monitor for any changes to NHSN reporting in the future and will provide updates if and when appropriate. Please send any questions to [email protected].

Telehealth “Waivers” Extended

Also effective April 1, Congress extended COVID-era telehealth “waivers” applicable to Medicare until September 30, 2025. These were originally scheduled to end March 31.

This latest extension will have the following impacts related to telehealth:

Telehealth at home: Medicare patients will continue to be able to receive telehealth services in their homes and in any location in the country through at least September 30, 2025.

New ICD-10-CM Coding Guidelines effective April 1, 2025

OBESITY

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. (The last part may not be of concern to you, but we wanted to let you know it is out there.)

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.

Source:

https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Publications/ICD10CM/2025-Update/