CMS has released the updates to the ICD-10-PCS classification and MS-DRG grouper (V42.1) that become effective on April 1, 2025. This Coding Tip covers the updates to the classification including additions, deletions and changes made in the References, Alphabetic Index, Code Tables and Official Guidelines for Coding and Reporting.
To ensure you are current on all ICD-10 code updates, make sure you read our related Coding Tip, ICD-10-CM Code Updates - April 1, 2025.
To download the updated files, use this link to the CMS website: https://www.cms.gov/medicare/coding-billing/icd-10-codes#. The files include an updated version of the guidelines, the index and the code tables as well as an addendum with files that include only the specific changes being made to the classification. Reviewing the addendum makes it easy to see exactly what is being changed/updated.
Use this link ICD-10 MS-DRGs Version 42.1 Effective April 01, 2025 for a complete list of the 50 new ICD-10-PCS codes along with the OR designation, MDC, and MS-DRG.
The April 1, 2025, update includes changes to five sections of ICD-10-PCS with the greatest number of changes being made in the Medical and Surgical and New Technology sections.
Here is a summary of the April 1, 2025, changes:
| 10/1/24 Total | New Codes | Revised Titles | Deleted Codes | 4/1/25 Total |
| 78,948 | 50 | 2 | 12 | 78,986 |
The are 5 code tables in the Medical and Surgical section of ICD-10-PCS that have updates and 1 new table that is being added for April 1, 2025.
0B1 Medical and Surgical, Respiratory System, Bypass
0CY Medical and Surgical, Mouth and Throat, Transplantation
0DX Medical and Surgical, Gastrointestinal System, Transfer
0SG Medical and Surgical, Lower Joints, Fusion
0TT Medical and Surgical, Urinary System, Resection
0U7 Medical and Surgical, Female Reproductive System, Dilation
There is only 1 code table in the Obstetrics section of ICD-10-PCS with updates for April 1, 2025.
10D Obstetrics, Pregnancy, Extraction
There is only 1 code table in the Administration section of ICD-10-PCS with updates for April 1, 2025.
3E0 Administration, Physiological Systems and Anatomical Regions, Introduction
Based on the Substance Definitions in ICD-10-PCS, this qualifier is used for reporting introduction of concentrated bone marrow aspirate (CBMA) which is a substance that has indications for treatment of osteoarthritis.
There is 1 new code table being added to the Radiation Therapy section of ICD-10-PCS for April 1, 2025.
D22 Radiation Therapy, Heart and Great Vessels, Stereotactic Radiosurgery
There are 6 code tables in the New Technology section of ICD-10-PCS with updates for April 1, 2025.
X2K New Technology, Cardiovascular System, Bypass
X2U New Technology, Cardiovascular System, Supplement
Based on the Device Definitions in ICD-10-PCS, this device value is used for reporting treatment of tricuspid valve insufficiency and caval reflux by insertion of TricValve(R) Transcatheter Bicaval Valve System. This procedure consists of percutaneous insertion of bioprosthetic valves in the superior and inferior vena cava at the points where they enter the right atrium. Although the device is being inserted within the vena cavae (intraluminal) the body part value is Atrium, Right because the objective of the device is to support (Supplement) the right atrium in pumping blood through the tricuspid valve and keeping circulation moving in the right direction by preventing backflow of blood from the atrium to the vena cavae.
More information about the TricValve(R) Transcatheter Bicaval Valve System can be found at the following links:
These videos are recommended to help with visualization of the procedure:
Two rows were added to this table to accommodate the addition of a new device, Ring External Fixation Device with Automated Strut Adjustment (G). This device is part of New Technology Group 10 (A). There are 14 potential body part values that can be assigned with this device. These consist of the right and left bones of the arm and leg.
Interestingly, a value of (4) was assigned for the body part Humeral Shaft, Right, even though a value of (4) has already assigned to the body part Thoracic Vertebra in a different row in this code table. This use of duplicate values for the body part character means it is necessary for another character value in the code to be used as a differentiator. In the case of code table XNS, a difference in the Device character value or the Qualifier character value can be used for this purpose. In instances where there are two options for a specific character value, the coder will just pick the option that corresponds to the documentation they are coding.
For both body parts of Peripheral Vein (3) and Central Vein (4) two new substance character values have been added, Emapalumab-lzsg Anti-IFNy Monoclonal Antibody (M) and Tarlatamab-dlle Antineoplastic (N).
Adding these new substances required the addition of rows to the table because they belong to New Technology Group 10 (A). This detail is important because the substance values of L, M and N are duplicated in this table, so the qualifier value that reports the specific New Technology Group that each substance belongs to will be used to differentiate codes from one another.
There are no updates to the ICD-10-PCS coding guideline included in the April 1, 2025, updates.
Note: There are also updates to the Alphabetic Index and the ICD-10-PCS Character Definitions, so coders should download all the files from the CMS.gov website referenced previously to have a complete copy of the changes/updates going into effect on April 1, 2025, to use as a reference when coding.
References
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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.