The proposed ICD-10 code changes — released with the FY2025 Hospital Inpatient PPS (IPPS) proposed rule on April 10 – include three new codes to better track the severity of patients with hypoglycemia.
The proposed rule includes 252 new codes, 13 revised code descriptors and 36 codes deemed invalid. If finalized, these changes would take effect Oct. 1.
A proposal including the new hypoglycemia codes was previously discussed during the virtual ICD-10-CM Coordination and Maintenance (C&M) Committee meeting in September 2023.
The proposed codes are:
- E16.A1 (Hypoglycemia level 1).
- E16.A2 (Hypoglycemia level 2).
- E16.A3 (Hypoglycemia level 3).
Hypoglycemia is broken down into a classification system of levels, the proposal in September explained:
- Level 1 is defined as a glucose concentration < 70 mg/dL and should be used as an ‘alert value’ to help individuals avoid more severe hypoglycemia.
- Level 2 is defined as a glucose concentration < 54 mg/dL, and is the threshold at which neuroglycopenic symptoms begin to occur.
- Level 3 is defined as a severe event characterized by altered mental and/or physical functioning.
“Hypoglycemia largely occurs in diabetes type I and diabetes type II patients,” the proposal states. “When the hypoglycemia severity level is documented, it demonstrates the impact on patient management, diabetic research and physician decisions to order continuous glucose monitoring systems (CGMs).”
Also proposed are new codes to capture patients who are presymptomatic for type 1 diabetes mellitus including E10.A0 (Type 1 diabetes mellitus, presymptomatic, unspecified, E10.A1 (Type 1 diabetes mellitus, presymptomatic, Stage 1) and E10.A2 (Type 1 diabetes mellitus, presymptomatic, Stage 2).
Encounter for sepsis aftercare
The proposed code update also includes a new code to capture a post-acute encounter for sepsis aftercare, Z51.A (Encounter for sepsis aftercare).
A proposal for this code was presented at the March 2023 ICD-10 C&M Committee meeting.
Experts previously noted that if this is finalized, they are hoping it could become a PDGM-approved diagnosis.
The new code would give clinicians the opportunity to warn patients and family members about the risks, such as new or recurrent infections, and could provide the chance to rehabilitate new impairments.
“Sepsis survivors have a high readmission risk due to post-acute complications and sequelae of sepsis after hospital discharge,” the March proposal stated before adding that around 40% of sepsis survivors discharged to post-acute care are readmitted to the hospital within 90 days.
More detail for eating disorders
The next ICD-10-CM update will replace four codes for anorexia nervosa, restricting type, anorexia nervosa, binge eating/purging type, bulimia nervosa and binge eating disorders with 24 codes that describe the stage of the condition.
For example, F50.2 (Bulimia nervosa), will be replaced with six codes:
- F50.20 (Bulimia nervosa, unspecified).
- F50.21 (Bulimia nervosa, mild).
- F50.22 (Bulimia nervosa, moderate).
- F50.23 (Bulimia nervosa, severe).
- F50.24 (Bulimia nervosa, extreme).
- F50.25 (Bulimia nervosa, in remission).
Two more proposed codes would address pica in adults (F50.83), a condition where adults eat things that aren’t usually considered food and rumination syndrome in adults (F50.84), a condition in which the patient regularly spits up food and either rechews and swallows or spits out the food shortly after they eat.
Additional proposals
- Expansion in the musculoskeletal and connective tissue codes. Two codes for intervertebral disc degeneration of the lumbar region (M51.36) and lumbosacral region (M51.37) will be replaced by seven new codes based on whether the patient has discogenic back pain, lower extremity pain or there is no mention of either type of pain. You’ll also say goodbye to M65.9 (Synovitis and tenosynovitis, unspecified) and hello to 23 codes that specify the site of the condition.
- More social determinants of health codes. The next code set will continue to refine social determinant of health codes by splitting Z59.7 (Insufficient social insurance and welfare support) into two codes that describe either insufficient health insurance coverage (Z59.71) or insufficient welfare support (Z59.72).
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FY 2025 proposed ICD-10-CM code updates
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ICD-10-CM Chapter
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New
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Revised
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Invalidated
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|
Chapter 1: Certain infectious and parasitic diseases (A00-B99)
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0
|
1
|
0
|
|
Chapter 2: Neoplasms (C00-D49)
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63
|
0
|
14
|
|
Chapter 3: Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)
|
1
|
0
|
0
|
|
Chapter 4: Endocrine, nutritional and metabolic diseases (E00-E89)
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16
|
0
|
2
|
|
Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01-F99)
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26
|
1
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4
|
|
Chapter 6: Diseases of the nervous system (G00-G99)
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7
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1
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1
|
|
Chapter 7: Diseases of the eye and adnexa (H00-H59)
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0
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5
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0
|
|
Chapter 8: Diseases of the ear and mastoid process (H60-H95)
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0
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0
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0
|
|
Chapter 9: Diseases of the circulatory system (I00-I99)
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4
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2
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0
|
|
Chapter 10: Diseases of the respiratory system (J00-J99)
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7
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0
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0
|
|
Chapter 11: Diseases of the digestive system (K00-K95)
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27
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1
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3
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Chapter 12: Diseases of the skin and subcutaneous tissue (L00-L99)
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8
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0
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3
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Chapter 13: Diseases of the musculoskeletal system and connective tissue (M00-M99)
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33
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0
|
3
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Chapter 14: Diseases of the genitourinary system (N00-N99)
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0
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0
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0
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Chapter 15: Pregnancy, childbirth and the puerperium (O00-O9A)
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0
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0
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0
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Chapter 16: Certain conditions originating in the perinatal period (P00-P96)
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0
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0
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0
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Chapter 17: Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99)
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4
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1
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1
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Chapter 18: Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
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1
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0
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0
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Chapter 19: Injury, poisoning and certain other consequences of external causes (S00-T88)
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30
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0
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3
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Chapter 20: External causes of morbidity (V00-Y99)
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0
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0
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0
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Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
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25
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1
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2
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Chapter 22: Codes for special purposes (U00-U85)
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0
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0
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0
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Total
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252
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13
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36
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