The 2025 ICD-10-CM updates, effective October 1, 2024, bring significant advancements with the introduction of new and expanded codes that reflect the ongoing evolution in medical knowledge, treatment practices, and value-based patient care. These updates are designed to capture a more nuanced understanding of clinical conditions, ensuring that coding remains in step with the latest medical insights and diagnostic standards.
For healthcare professionals, it is imperative to adapt to these changes to maintain the accuracy, compliance, and efficiency of coding processes, which directly impact reimbursement outcomes and overall healthcare quality. In the sections below, we provide an in-depth overview of the key updates relating to cognitive, mental health, and nervous system codes, along with practical guidance to help you navigate these changes seamlessly and ensure your coding processes remain aligned with the most current standards.
What’s New for 2025?
The 2025 updates to the ICD-10-CM Tabular List demonstrate a continued commitment to improving coding precision and clinical relevance. These updates place a strong emphasis on coding specificity, ensuring that healthcare professionals can accurately capture the complexity of patient conditions while aligning documentation with current clinical practices.
1. Mental, Behavioral, and Neurodevelopmental Disorders (Chapter 5)
Mental and Behavioral Disorders: These revisions bring enhanced precision and clarity to the documentation of mental and behavioral health conditions. Key changes include refined coding instructions and updated terminology for dementia-related conditions, schizophrenia, and vascular dementia. Specific updates address the classification of neurocognitive disorders, emphasizing the importance of capturing causal conditions and associated cognitive deficits to provide a comprehensive view of patient health and care needs.
- F01 Vascular dementia—code first instruction:
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- Deleted: ‘the underlying physiological condition or sequelae of cerebrovascular disease.’
- Added: ‘if applicable, any causal condition’
- F02 Dementia in other diseases classified elsewhere—code first instruction:
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- Deleted: ‘dementia with Lewy bodies (G31.83)’
- Deleted: ‘dementia with Parkinsonism (G31.83)’
- Added: ‘neurocognitive disorder with Lewy bodies (G31.83)’
- Added: ‘other frontotemporal neurocognitive disorder (G31.90)’
- F03 Unspecified dementia—excludes 1 note:
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- Deleted: ‘senility NOS (R41.81)’
- F03 Unspecified dementia—excludes 2 note:
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- Deleted: ‘senile dementia with delirium or acute confusional state (F05)’
- Added: ‘dementia with delirium or acute confusional state (F05)’
- F20 Schizophrenia—see additional code instruction:
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- Added: ‘other specified cognitive deficit (R41.84-)’
Expanded Eating Disorder Codes: The latest updates introduce new severity-level codes for eating disorders such as anorexia, bulimia, and binge eating, providing greater precision in documentation and reporting. These updates reflect the complexity of eating disorders, which extend far beyond caloric restriction. These are serious, potentially life-threatening illnesses that intertwine psychological and physical health, often rooted in deep-seated feelings of self-control and emotional challenges.
- F50.01–: Anorexia nervosa, restricting type, (severity specified/unspecified)
- F50.02–: Anorexia nervosa, binge eating/purging type, (severity specified/unspecified)
- F50.20: Bulimia nervosa, unspecified
- F50.21–F50.25: Bulimia nervosa, (severity specified)
- F50.81–: Binge eating disorder, (severity specified/unspecified)
- Code selection is based on the severity and course (e.g., mild, severe). Report 'unspecified’ when the documentation does not clearly identify the severity.
Additionally, conditions such as Pica and Rumination Disorder now include codes for adult populations. Pica is characterized by the repeated consumption of non-food materials, such as dirt or paper, while Rumination Disorder involves the regurgitation of undigested or partially digested food from the stomach.
- F50.83: Pica in adults
- F50.84: Rumination disorder in adults
2. Diseases of the Nervous System (Chapter 6)
Neuropsychological and Cognitive Disorders: These updates focus on improving precision and clarity in code language. Notable changes include updated exclusions for conditions such as secondary parkinsonism, Alzheimer’s disease, and mild cognitive impairment, incorporating refined terminology and updated classification of related disorders to reflect the latest clinical insights.
- G21 Secondary parkinsonism—excludes 1 note:
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- Revised from: ‘senile dementia NOS (F03)’
- Revised to: ‘senile dementia NOS (F03.-)’
- G30 Alzheimer's disease—excludes 1 note:
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- Revised from: ‘senile dementia NOS (F03)’
- Revised to: ‘senile dementia NOS (F03.-)’
- G31.84 Mild cognitive impairment of uncertain or unknown etiology—excludes 1 note:
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- Deleted: ‘dementia with Parkinsonism (G31.83)’
- Added: ‘neurocognitive disorder with Lewy bodies (G31.83)’
Expanded Epilepsy Codes: The addition of new codes for KCNQ2-related epilepsy enhances precision in reporting this genetic disorder, which stems from mutations in the KCNQ2 gene—a key regulator of neuronal excitability. This rare condition typically manifests as early-onset epilepsy and is often accompanied by a spectrum of neurological impairments, including developmental delays and cognitive challenges.
- G40.84–:KCNQ2-related epilepsy
- Code selection is based on the type:
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- SeLNE (self-limited familial neonatal epilepsy): most common; (also known as: benign familial neonatal epilepsy, benign neonatal convulsions, benign idiopathic neonatal seizures, and "fifth day fits" (related to common day of onset)
- SeLFNIE: self-limited (familial) neonatal-infantile epilepsy
Overview of Key ICD-10-CM Coding Guidelines
The ICD-10-CM coding guidelines provide the framework for accurate and compliant coding, ensuring consistency across clinical documentation and reimbursement processes. Although there are no major updates to the coding guidelines in the 2025 release for mental, behavioral, and cognitive health, it is crucial to revisit and reinforce the foundational principles established in Chapters 5 and 6.
This overview serves to reinforce understanding and proper application of the guidelines related to Mental, Behavioral, and Neurodevelopmental Disorders (Chapter 5) and Diseases of the Nervous System (Chapter 6). By reviewing these guidelines, healthcare professionals can ensure precision in code selection, align with clinical scenarios, and uphold compliance with ICD-10-CM standards.
Chapter 5: Mental, Behavioral, and Neurodevelopmental Disorders (F01–F99)
1. Pain Disorders Related to Psychological Factors: Differentiates between psychological pain (F45.41) and combined psychological/physical pain (F45.42), with coding rules for co-reporting with G89 codes.
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- F45.41: Pain disorder exclusively related to psychological factors (not co-reported with G89).
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- F45.42: Pain disorder with related psychological factors (co-reported with G89).
2. Substance Use Disorders: Highlights the importance of remission documentation, hierarchical coding rules and linking substance-related conditions with associated medical diagnoses, including coding for blood alcohol levels when documented.
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- “In Remission” Codes: Require clear provider documentation of remission status and severity.
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- Hierarchy Rules: Dependence > Abuse > Use. Only one code is assigned, following hierarchical guidance.
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- Medical Condition Links: Assign both substance-related and medical condition codes (e.g., alcoholic pancreatitis and alcohol dependence).
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- Blood Alcohol Levels: Use Y90 codes when documented, even if noted by clinicians other than the provider.
3. Factitious Disorders: Provides coding guidance for factitious disorders on self (F68.1–) and imposed on another (F68.A), with abuse codes assigned for victims of imposed disorders.
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- F68.1–: Factitious disorder imposed on self (e.g., Munchausen’s syndrome).
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- F68.A: Imposed on another (e.g., Munchausen’s by Proxy).
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- For the victim, assign abuse codes from Chapter 19 (T74.–/T76.–).
4. Dementia: Includes coding guidance pertaining to documentation of severity levels (mild, moderate, severe), coding progression during inpatient stays, and selecting codes based on the underlying etiology, such as Alzheimer’s disease (F01).
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- Severity Levels: Document mild, moderate, or severe stages, using progression codes during inpatient stays as needed.
- Etiology: Select codes based on underlying cause, e.g., Alzheimer’s disease (F01).
Chapter 6: Diseases of the Nervous System (G00–G99)
1. Dominance Assignment: Guidelines for assigning dominance when coding conditions affecting limbs, such as codes from category G81, Hemiplegia and hemiparesis, and subcategories G83.1, Monoplegia of lower limb, G83.2, Monoplegia of upper limb, and G83.3, Monoplegia, unspecified, based on whether the affected side is dominant, non-dominant, or ambidextrous.
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- Ambidextrous: Default to dominant.
- Left side affected: Non-dominant.
- Right side affected: Dominant.
2. Pain Coding (G89): Instructions for using G89 codes to document acute, chronic, or neoplasm-related pain, with guidance on sequencing based on the focus of care.
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- When to Use G89 Codes: For acute, chronic, or neoplasm-related pain, especially when pain management is the focus of care.
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- Pain management: Code G89.- first.
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- Other reasons: Site-specific code first, followed by G89.- code.
3. Postoperative Pain: Differentiates routine postoperative pain from complicated cases, with coding instructions for assigning G89 and complication codes.
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- Routine vs. Complicated Pain: Routine or expected postoperative pain immediately after surgery should not be coded. Code only complicated cases, assigning G89 alongside Chapter 19 codes for complications.
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- Acute vs. Chronic: The default for post-thoracotomy and other postoperative pain not specified as acute or chronic is the code for the acute form.
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- G89.12: Acute post-thoracotomy pain
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- G89.18: Other acute postprocedural pain
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- G89.22: Chronic post-thoracotomy pain
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- G89.28: Other chronic postprocedural pain
4. Chronic Pain and Syndromes: Clarifies the use of G89.2 for chronic pain based on provider documentation and G89.4 for chronic pain syndrome, emphasizing that these codes are not interchangeable.
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- Chronic Pain (G89.2): Defined by provider documentation; no strict timeframe for classification.
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- Chronic Pain Syndrome (G89.4): Assigned only when explicitly documented, not interchangeable with chronic pain.
5. Neoplasm-Related Pain (G89.3): Sequencing rules for pain related to neoplasms, specifying when G89.3 should be listed as the principal diagnosis or secondary to neoplasm management.
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- Pain management focus: Code G89.3 as principal diagnosis.
- Neoplasm management: Report neoplasm first, followed by G89.3 code.
A Crucial Focus of Coding Specificity
ICD-10-CM mandates that codes be reported with the highest level of specificity to ensure accurate coding and avoid claim denials or delays. This approach not only promotes compliance with established guidelines but also supports timely reimbursement and optimal care coordination. Here’s a breakdown:
- Three-Character Codes: These serve as categories and are used only if no further subdivisions exist.
- Four to Seven Characters: Provide additional detail, such as anatomical specificity, severity, or episode of care.
- Seventh Character Extensions: Vital for injury coding, indicating factors like episode of care or healing status.
Incomplete codes can disrupt reimbursement and compliance efforts. Always verify the code structure and ensure clinical documentation supports the chosen code’s specificity.
Understanding Includes and Excludes Notes in ICD-10-CM Coding
To ensure accurate coding and adherence to ICD-10-CM guidelines, it is vital to understand the purpose and correct application of Includes and Excludes notes. These notes serve as crucial tools for guiding coding decisions, helping to determine which codes can or cannot be used together. Their primary aim is to clarify relationships between conditions, prevent coding conflicts, and promote precise and compliant reporting practices. By leveraging these notes effectively, coders can enhance documentation accuracy and ensure alignment with clinical scenarios.
Includes Notes
Includes notes appear directly below a three-character code title and serve to:
- Further define the category or subcategory.
- Provide examples or conditions relevant to the code.
Inclusion Terms:
- Found under some codes, these terms represent conditions assignable to that code.
- The terms may be synonyms of the code title or examples of conditions included under "other specified" codes.
- Note that these lists are not exhaustive; additional terms in the Alphabetic Index may also apply to the code.
Proper Use:
- Use Includes notes to confirm that the selected code accurately reflects the documented condition.
Excludes Notes
ICD-10-CM employs two types of Excludes notes—Excludes 1 and Excludes 2—each with specific implications for coding.
Excludes 1 Notes (“Not Coded Here”)
- Indicates that the excluded code must never be used simultaneously with the code it accompanies.
- Typically applies when two conditions cannot coexist, such as congenital versus acquired forms of the same condition.
- Exceptions: If the two conditions are clearly unrelated, both codes may be used. In unclear cases, a provider query is necessary.
Excludes 2 Notes (“Not Included Here”)
- Indicates that the excluded condition is not part of the condition represented by the code.
- However, the patient may have both conditions simultaneously.
Proper Use:
- Review Excludes 1 and Excludes 2 notes to determine whether a code combination is valid.
- Use Excludes 2 notes to report both conditions if they coexist, as they are independent of one another.
Understanding Etiology / Manifestation Coding Convention
The etiology/manifestation coding convention in ICD-10-CM ensures accurate sequencing when documenting conditions with both an underlying etiology and related manifestations affecting multiple body systems. This convention is critical for coding conditions such as Dementia and Parkinson’s Disease, as it dictates the proper order in which codes must be reported to maintain compliance and ensure correct reimbursement.
Key Principles of the Etiology/Manifestation Convention
- Sequencing Order: The key principles of the etiology/manifestation convention highlight the proper sequencing and structure of coding for conditions with an underlying etiology and its resulting manifestation. The underlying condition, or etiology, must always be listed first, followed by the manifestation code, which should never be reported as the principal diagnosis.
- Instructional Notes in the Tabular List: In the Tabular List, instructional notes play a crucial role in guiding the coder. At the etiology code, a “use additional code” note will indicate that the associated manifestation code should be included. Conversely, at the manifestation code, a “code first” note will emphasize the need to sequence the underlying condition first.
- Manifestation Code Titles: Many manifestation codes are titled with the phrase “in diseases classified elsewhere,” explicitly linking them to a specific underlying etiology. These codes are never permitted to be used as standalone diagnoses and must always be reported in conjunction with the appropriate etiology code.
- Alphabetic Index Structure: In the Alphabetic Index, both the etiology and manifestation codes are listed together, with the etiology code appearing first, followed by the manifestation code in brackets. This structure signals the correct sequencing order for coding.
Specific Guidance for Dementia with Parkinson’s Disease
Dementia, also referred to as major neurocognitive disorder, involves a substantial decline in cognitive functions, including memory, problem-solving, attention, and language skills. It often results from an underlying disorder such as Parkinson’s disease, cerebrovascular disease, or Alzheimer’s disease. In some cases, the specific underlying etiology cannot be determined.
Key Coding Considerations
Code selection should reflect the severity of dementia (e.g., mild, moderate) and the presence of associated symptoms, such as:
- Behavioral and Psychological Symptoms of Dementia (BPSD)
- Non-Cognitive Behavioral Changes (NCBC)
- Neuropsychiatric Symptoms (NPS)
Consider the following coding guidelines for accurate reporting:
1. Underlying Etiology Code
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- G20–: Parkinson’s disease (serves as the primary etiology code).
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- G20.A–: Parkinson's disease without dyskinesia
- G20.B–: Parkinson's disease with dyskinesia
- G20.C: Parkinsonism, unspecified
2. Manifestation Code(s):
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- F02.80: Dementia in other diseases classified elsewhere, without behavioral disturbance.
- F02.81–: Dementia in other diseases classified elsewhere, with behavioral disturbance.
3. Proper Sequencing:
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- G20- (Parkinson’s disease) is sequenced first as the underlying condition.
- F02.80 or F02.81– (manifestation of dementia) follows as the secondary code.
Instructional Notes:
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- At G20–, there is a “use additional code” note directing coders to include the appropriate manifestation code.
- At F02.80/F02.81–, there is a “code first” note indicating that Parkinson’s disease must be listed first.
Alphabetic Index Entry: In the Alphabetic Index, the entry for "Dementia with Parkinson’s Disease" appears as:
- Parkinson’s disease G20.– [F02.80, F02.81–]: This notation reflects the required sequencing, with G20.– code listed first and the dementia specific codes in brackets to be reported second.
Specificity in Documentation:
- Ensure the provider’s documentation clearly identifies the relationship between the etiology and the manifestation.
- Specify whether the dementia includes behavioral disturbances, as this determines whether F02.80 (without behavioral disturbance) or F02.81– (with behavioral disturbance) is assigned.
Behavioral and Psychological Symptoms of Dementia
Accurate coding in the tracking of dementia and its associated behavioral disturbances is paramount to ensuring optimal treatment and care coordination. Before October 1, 2022, behavioral disturbances in dementia were reported using a broad, generalized classification. However, recent updates have introduced a more refined approach, providing granular, specific categories that are essential for comprehensive patient management and tailored treatment plans.
These updates not only enhance the precision of clinical documentation but also support the identification of critical behavioral patterns, which are crucial for both healthcare providers and researchers. The more detailed coding structure enables better tracking of disease progression and aids in delivering personalized care.
These categories include:
- Without Behavioral Disturbances
- With Anxiety
- With Agitation
Includes a variety of behaviors such as: aggression (physical, verbal), including profanity, shouting, threats, anger, combativeness, or violence; combativeness; violent behavior; anger; aberrant motor behavior, such as rocking, pacing, restlessness, and exit-seeking; and verbal or physical aggression, including threats and anger.
- With Mood Disturbance
Includes: depression; apathy; anhedonia (lack of pleasure); and euphoria (excessive happiness).
- With Other Behavioral Disturbance
Includes: sleep disturbances; social disinhibition, such as intrusiveness; and sexual disinhibition.
- With Psychotic Disturbance
Includes: hallucinations; paranoia; suspiciousness; and delusional states.
These specific distinctions are essential for patient care, as they provide more precise information that directly impacts management strategies and treatment decisions. These coding changes highlight the importance of capturing the full spectrum of severity and progression in dementia. This level of granularity is critical not only for enhancing patient outcomes but also for advancing clinical research.
Given dementia’s progressive nature, these updates enable the collection of more comprehensive, longitudinal data, which is vital for understanding the disease's trajectory. By incorporating these ICD-10-CM combination codes, healthcare providers gain deeper insight into the variability of individual patients, allowing for more personalized and effective care.
Positioning for Success: Navigating the 2025 ICD-10-CM Updates
The 2025 ICD-10-CM updates and established guidelines mark a pivotal advancement in coding accuracy, clinical relevance, and reimbursement optimization. By proactively adapting to these changes, healthcare professionals can enhance compliance, reduce denials, and support improved patient care while optimizing provider efficiency.
Embracing these updates paves the way for success in 2025, promoting streamlined workflows, financial sustainability, and superior outcomes across the healthcare continuum. This alignment with value-based care initiatives underscores the critical role accurate coding plays in advancing quality care and operational excellence.
References
ICD-10-CM Guidelines FY25 October 1, 2024
ICD-10 | CMS
What is the ICD-10 Code For Dementia?. (2023, March 14). Find-A-Code Articles. https://www.findacode.com/articles/icd-10-code-dementia-37352.html