11 Min Read
SaMeD RCM Solutions Team
Medical coding plays a critical role in healthcare reimbursement. Accurate coding ensures that medical services, procedures, and diagnoses are properly represented on insurance claims.
However, coding guidelines and code sets are updated regularly to reflect changes in medical practices, new technologies, clinical procedures, and healthcare reporting requirements.
The 2025 coding updates introduced important changes across ICD-10-CM, CPT, and HCPCS Level II. For medical practices, billing companies, and coding professionals, understanding these changes is essential for maintaining accurate claims, reducing avoidable denials, and supporting compliant reimbursement practices.
Even a small coding oversight can result in claim rejections, payment delays, incorrect reimbursement, or additional administrative work.
In this article, SaMeD RCM Solutions highlights important 2025 medical coding updates and explains what healthcare providers and billing teams should know.
The ICD-10-CM system is used in the United States to classify diagnoses, symptoms, and reasons for healthcare encounters.
The FY 2025 ICD-10-CM update became effective October 1, 2024, with an additional update to the code files effective April 1, 2025.
These updates are important because diagnosis codes must accurately reflect the patient’s documented condition and the applicable coding guidelines.
Billing and coding teams should:
Using an outdated or invalid diagnosis code may result in claim rejections or other processing problems.
Additionally, a diagnosis code that is not supported by the clinical documentation may create compliance and reimbursement concerns.
Best Practice: Make sure your coding team uses the appropriate ICD-10-CM code set based on the date of service and reviews official coding guidelines before submitting claims.
The American Medical Association (AMA) released the CPT 2025 code set with significant changes reflecting advancements in medical technology, diagnostic services, and clinical procedures.
The 2025 CPT code set included:
These changes affected several areas of medical practice and procedure reporting.
A. Remote Therapeutic Monitoring (RTM)
Updates were made to remote therapeutic monitoring codes to better describe digital therapeutic interventions and device-related data transmission.
For example, CPT code 98975 was revised to include digital therapeutic intervention, while codes 98976–98978 received revisions related to device supply and data transmission.
Medical practices providing remote therapeutic monitoring services should review the updated code descriptions and applicable reporting requirements.
B. Artificial Intelligence (AI) in Healthcare
The 2025 CPT code set continued to address emerging artificial intelligence applications in healthcare.
New Category III codes were introduced for certain AI-related services, including applications involving:
These developments demonstrate how medical coding continues to evolve alongside new healthcare technologies.
C. General Surgery and Wound Care
Updates were also made to the general surgery section.
These included new and revised codes relating to:
Providers and coding professionals should review the applicable code descriptors and documentation requirements before reporting these services.
Best Practice: Never assume that a previously used CPT code remains appropriate for a new date of service. Always verify the current code description and applicable reporting requirements.
HCPCS Level II codes identify products, supplies, equipment, and certain services that are not represented by CPT codes.
These codes are particularly relevant for practices and suppliers billing for:
CMS maintains HCPCS Level II codes and publishes updates throughout the year.
Rather than relying only on an annual update, billing teams should monitor quarterly HCPCS releases.
Changes may include:
Using an outdated HCPCS code or an incorrect code description can create billing and reimbursement problems.
Practices should confirm that the reported code accurately represents the product or service provided and meets the applicable payer requirements.
Best Practice: Review the CMS HCPCS quarterly update files and confirm effective dates before submitting claims.
The National Correct Coding Initiative (NCCI) is designed to promote correct coding methodologies and help prevent improper payments.
NCCI edits are particularly important when multiple procedures or services are reported on the same claim.
Two important types of NCCI edits include:
Procedure-to-Procedure (PTP) Edits
These edits identify code combinations that generally should not be reported together under applicable coding rules, subject to any permitted exceptions.
Medically Unlikely Edits (MUEs)
MUEs help identify potentially incorrect units of service reported for individual HCPCS/CPT codes.
Best Practice: Review current NCCI edits before claim submission and ensure that any modifier used to report an otherwise restricted combination is supported by documentation and applicable policy.
Even when the correct code is selected, insufficient clinical documentation can create reimbursement problems.
Coding professionals must ensure that the selected diagnosis and procedure codes accurately reflect the services documented by the provider.
Important documentation considerations include:
A coding decision should never be based solely on the expectation of higher reimbursement.
Best Practice: Establish a regular documentation review process and communicate with providers when clarification is needed.
Despite regular updates and training, coding mistakes remain a challenge for many healthcare organizations.
Some common problems include:
1. Using Outdated Codes
Continuing to use codes that have been revised or deleted can result in claim submission problems.
2. Incorrect Diagnosis Selection
Selecting diagnosis codes that do not accurately represent the documented clinical condition can affect claim processing and compliance.
3. Incorrect Modifier Usage
Missing or unsupported modifiers can result in denials, incorrect reimbursement, or additional payer review.
4. Incorrect Units of Service
Reporting more or fewer units than supported by the documentation or applicable billing rules can create reimbursement issues.
5. Ignoring NCCI Edits
Failing to review applicable coding edits can result in improper code combinations or avoidable denials.
6. Inadequate Documentation
Insufficient clinical documentation may not support the diagnosis, procedure, or level of service reported.
7. Failure to Update Billing Software
Outdated code libraries and billing system configurations can contribute to preventable claim errors.
Preparing for coding updates requires coordination between providers, coding professionals, billing teams, and practice administrators.
Here are seven practical steps:
1. Conduct Regular Coding Training
Ensure coding professionals understand applicable annual and quarterly updates.
2. Update Coding Software
Work with your EHR, practice management system, and clearinghouse vendors to maintain current code libraries and claim edits.
3. Review Payer Policies
Medicare, Medicaid, and commercial insurance companies may have different coverage, authorization, and reimbursement requirements.
4. Perform Regular Coding Audits
Review a sample of submitted claims to identify coding inconsistencies, documentation gaps, and recurring errors.
5. Monitor Denial Trends
Analyze denials related to diagnosis codes, procedure codes, modifiers, medical necessity, and other coding issues.
6. Improve Provider Communication
Create a clear process for communicating documentation concerns and obtaining clarification when necessary.
7. Monitor Official Coding Resources
Use authoritative sources such as CMS, CDC, and AMA publications instead of relying solely on informal coding discussions.
Medical coding is directly connected to the financial performance of a healthcare practice.
Incorrect coding can contribute to claim rejections, denials, payment delays, and additional administrative work.
A structured coding and billing process can help practices:
Coding accuracy should therefore be treated as an essential part of revenue cycle management rather than an isolated administrative task.
At SaMeD RCM Solutions LLC, we understand that coding accuracy is essential to maintaining a reliable revenue cycle.
Our team supports healthcare practices across the United States with medical billing and revenue cycle management services designed to help identify billing issues, improve claim workflows, and support appropriate reimbursement.
Our services include:
We work with multiple medical specialties and understand the importance of accurate coding, complete documentation, and consistent claim follow-up.
Our objective is to help healthcare practices strengthen their billing operations and reduce preventable revenue leakage.
Medical coding updates are an important part of maintaining accurate and compliant healthcare billing operations.
The 2025 updates to ICD-10-CM, CPT, and HCPCS Level II highlight the importance of staying informed, maintaining current coding references, and reviewing applicable payer requirements.
For healthcare practices, the responsibility does not end with learning new codes. These changes must also be reflected in documentation workflows, billing software, claim reviews, and staff training.
A proactive approach to coding accuracy can help reduce avoidable billing issues and support a more efficient revenue cycle.
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1. What were the major medical coding updates in 2025?
The major updates included changes to ICD-10-CM, CPT, and HCPCS Level II. CPT 2025 included 270 new codes, 112 deletions, and 38 revisions. ICD-10-CM also received its FY 2025 update and an April 2025 code-file update.
2. When did the 2025 ICD-10-CM updates become effective?
The FY 2025 ICD-10-CM update became effective October 1, 2024. Additional code-file updates became effective April 1, 2025.
3. What is the difference between CPT and HCPCS Level II?
CPT, maintained by the American Medical Association, is used primarily to report medical procedures and professional services. HCPCS Level II, maintained by CMS, identifies items and services not included in CPT, such as certain medical supplies, equipment, and ambulance services.
4. Why are annual coding updates important for medical practices?
Coding updates help ensure that claims reflect current code descriptions, reporting requirements, and applicable guidelines. Using outdated or incorrect codes can contribute to rejections, denials, and payment delays.
5. How can medical practices stay updated with coding changes?
Practices should monitor official CMS, CDC, and AMA publications, update billing systems, conduct regular coding audits, and provide ongoing training to billing and coding professionals.
6. Can coding errors lead to insurance claim denials?
Yes. Incorrect diagnosis codes, procedure codes, unsupported modifiers, inaccurate units, and insufficient documentation can contribute to claim denials or other processing problems.
Disclaimer: This article is intended for general educational purposes only and does not constitute legal, coding, or reimbursement advice. Coding requirements and payer policies may change. Always verify applicable codes, effective dates, official coding guidelines, and payer-specific requirements before submitting claims.
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