Healthcare providers need to stay informed about Healthcare Coding Updates to the Current Procedural Terminology (CPT), International Classification of Diseases (ICD-11), and Healthcare Common Procedure Coding System (HCPCS) in the ever-evolving world of medical coding and billing. To ensure accurate coding and maximize revenue cycles, we must understand these Healthcare Coding Updates as we enter 2025. Understanding these changes impacts reimbursement, compliance, and overall operational efficiency in healthcare practices.
Our newsletter provides a detailed breakdown of the upcoming 2025 updates to CPT, ICD-11, and HCPCS codes, as well as actionable guidance for implementing them.
2025 CPT Code Updates
For 2025, the American Medical Association (AMA) has made several significant changes to the CPT code set to reflect new procedures, emerging technologies, and changes in medical practice. These are:
New Additions
- Telehealth Services: The CPT code sets have been updated to reflect the continued expansion of telemedicine. These include codes for chronic condition management and mental health services delivered virtually.
- Surgical Innovations: The ICD-10 has been updated to include new codes for advanced laparoscopic and robotic procedures, which address minimally invasive techniques in cardiac, orthopedic, and gastrointestinal surgery.
- Artificial Intelligence (AI) and Machine Learning: The integrated use of AI tools in diagnostics and imaging has resulted in the creation of new CPT codes that capture AI-assisted radiology interpretations and pathology interpretations.
Revised Codes
- Evaluation and Management (E/M) Services: The updated requirements aim to simplify documentation requirements, increase medical decision-making, and reduce time-based reporting requirements.
- Laboratory Testing: Laboratory codes have been revised to take into account genetic screenings and personalized medicine tests.
Deleted Codes
Codes that are no longer in use or that are obsolete have been removed, especially those that are no longer applicable in areas where standard practices or technologies no longer apply.
Implementation Tips
- Check the most commonly used CPT codes in your practice to determine if any changes need to be made.
- Provide training to coders and clinicians on the new codes and requirements for documentation.
- Update billing software and templates to reflect changes to the CPT in 2025.
Transition to ICD-11
Currently, many countries, including the U.S., are preparing to adopt ICD-11, which is the latest version of the World Health Organization’s (WHO) global standard for health information.
Key Differences from ICD-10
- Digital Readiness: A major advantage of ICD-11 is its ability to integrate with electronic health record (EHR) systems, which facilitates easier use and accessibility.
- Expanded Code Set: Over 55,000 codes are included in the code set, which allows for a higher level of specificity in describing diagnoses and conditions.
- New Features: There are enhancements in the code structure, such as the capability to capture laterality, severity, and causal relationships directly.
Notable Updates for 2025
- Mental Health: Updated codes for substance use disorders and neurodevelopmental conditions have been added to the classification of mental and behavioral disorders.
- Rare Diseases: Research and public health tracking are improved with extended codes for rare and complex conditions.
- Injuries and External Causes: Trauma care and prevention programs will benefit from detailed injury classifications and external cause codes.
Transition Strategies
- Assist staff in becoming familiar with the new system by performing dual coding (ICD-10 and ICD-11).
- ICD-11 compatibility should be ensured by collaborating with EHR vendors.
- Take part in ICD-11 coding training programs and webinars to gain a deeper understanding of the system.
2025 HCPCS Code Updates
Each year, the Centers for Medicare & Medicaid Services (CMS) updates the HCPCS Level II code set to reflect changes in products, services, and technologies used in patient care.
New Codes
- Medications and Biologics: The list has been updated with new codes for drugs and biologics approved for cancer therapy, autoimmune disease therapies, and genetic disorders therapies.
- Durable Medical Equipment (DME): Innovating DME products, such as home monitoring systems and mobile mobility devices, are addressed in the new codes.
- Preventive Services: Updated clinical guidelines align preventive screenings and vaccinations with the new codes.
Revised Codes
Updates to existing codes aim to improve clarity and eliminate ambiguities. For example, advances in material technology are reflected in updates to prosthetic and orthotic device codes.
Deleted Codes
A number of discontinued and obsolete codes have been removed from the code list in order to streamline it.
Implementation Tips
- To ensure that your practice’s supply chain partners are billing using the latest HCPCS codes, verify that they are using them.
- Provide your billing team with information on the changes to avoid denials and delays in reimbursement.
- CMS announcements regarding quarterly updates and corrections to the HCPCS code set should be monitored.
Practical Steps for Providers
Audit and Assessment
- Identify areas where your practice may be at risk of non-compliance with the 2025 updates by conducting a coding audit.
- Coding errors can be addressed and documentation practices can be improved by taking advantage of this opportunity.
Staff Training
- Coders, billers, and clinicians should have regular training sessions and resources.
- Provide staff with online resources, workshops, and certification programs so that they can stay up to date.
Technology Upgrades
- Update your electronic health record and practice management system to accommodate the new code sets.
- To resolve any technical issues, work with vendors to test the functionality of the system.
Communication with Payers
- Confirm that insurance companies are ready to process claims using the updated codes by engaging with them.
- Provide clarification on any payer-specific policies or requirements related to the 2025 updates.
Future Trends to Watch
Increased Automation
- Automation and machine learning will be increasingly integrated into coding and billing processes, reducing manual errors and increasing efficiency.
Value-Based Care Models
- Increasing reliance on value-based care will require accurate coding to determine reimbursements and measure outcomes.
Global Standardization
- Healthcare data reporting and analysis will become more consistent across countries with the adoption of ICD-11.
Healthcare is dynamic, and accurate coding is essential to ensure quality care and appropriate reimbursement, which is why Healthcare Coding Updates to CPT, ICD-11, and HCPCS codes will be implemented in 2025. In an increasingly complex healthcare landscape, providers can stay informed and proactive to navigate these Healthcare Coding Updates effectively.
Review your practice’s coding workflows, invest in training, and partner with technology providers to ensure a seamless transition. Together, we can continue to deliver excellent care under these new standards.