Navigating the FY 2025 ICD-10-CM Updates: A Cliniqon Guide for Home Health & Hospice Agencies

Starting October 1, 2025, the Centers for Medicare & Medicaid Services (CMS), along with the Centers for Disease Control and Prevention (CDC), will implement critical updates to the ICD-10-CM coding system. These changes include:

• 487 new diagnosis codes

• 38 revised code descriptions

• 28 deleted (invalid) codes

These updates aim to improve diagnostic precision, reflect current clinical practices, and strengthen public health data reporting. For Home Health and Hospice agencies, staying informed and prepared is essential to ensure coding accuracy, maintain compliance, and protect reimbursement.

Key ICD-10-CM Changes and Their Impact

New Codes (487)

The newly added codes provide expanded detail for diagnoses frequently seen in post-acute care. Notable additions include:

• Non-pressure ulcer codes categorized by stage

• Specific codes for breast cancer-related conditions

• Social determinants of health (e.g., housing and financial insecurity)

• Enhanced classification for multiple sclerosis and thyroid eye disease

These changes allow providers to better capture patient acuity—an important factor in PDGM calculations and Hospice eligibility.

Revised Code Descriptors (38)

Descriptor changes clarify terminology, staging, laterality, and anatomical locations. While some revisions appear minor, they can significantly affect:

• Clinical documentation requirements

• Code selection and grouping logic

• Accuracy of OASIS responses and assessments

Inaccurate or outdated descriptors may lead to documentation and coding inconsistencies, increasing the risk of claim denials or audit findings.

Deleted Codes (28)

These codes will be invalid for billing after October 1, 2025. Continued use may result in:

• Claim rejections

• Delayed reimbursement

• Compliance risks during audits

Agencies must ensure these codes are removed from EMR templates, diagnosis libraries, and Plan of Care defaults prior to implementation.

Why These Updates Matter to Home Health & Hospice Agencies

Under PDGM and Hospice billing frameworks, coding plays a pivotal role in reimbursement, compliance, and performance metrics. The FY 2025 updates directly impact:

• Claim rejections - Accurate codes affect case-mix adjustment and payment rates.

• Regulatory Compliance – Updated documentation must align with new coding standards

• Operational Efficiency – Eliminating outdated codes prevents claim rework and delays

• Quality Performance – Reliable coding supports better outcomes and Star Ratings

How Cliniqon Can Support Your Transition

At Cliniqon, we help Home Health and Hospice agencies stay ahead of regulatory changes through specialized coding and QA services. As the 2025 ICD-10-CM updates take effect, we offer:

• Certified coders fully trained on the FY 2025 updates, including new, revised, and retired codes

• Strict adherence to CMS and CDC guidelines, ensuring every code applied is accurate and compliant

• Ongoing education for clinicians and staff, promoting strong documentation practices that support coding integrity

• Consistent QA review of coded charts, reducing denials and supporting clean, timely claim submissions

By integrating these services into your workflow, Cliniqon helps your team maintain focus on patient care—while we handle the complexities of accurate, compliant coding.

What Makes Cliniqon Different

We don’t just deliver coding and QA—we deliver results. At Cliniqon, our mission is to support agencies in:

• Staying compliant with CMS regulations

• Maximizing reimbursement through precise coding

• Improving care quality by aligning documentation with best practices

Our team brings proactive guidance, deep expertise in Home Health and Hospice, and adaptable solutions that fit your workflow. We work behind the scenes so your agency can stay ahead of regulatory shifts and focus on what truly matters—providing exceptional patient care.

Ready to Transition with Confidence?

Let Cliniqon be your partner in navigating the ICD-10-CM updates. Contact us today to schedule a readiness assessment and receive a customized implementation plan. With Cliniqon by your side, you can stay compliant, reduce risk, and continue delivering high-quality care without disruption.