ICD-10 and CPT Code Updates – What You Need to Know

In the ever-evolving world of healthcare, coding systems play a pivotal role in ensuring accurate billing, effective treatment documentation, and compliance with regulatory requirements. Two of the most essential coding standards in the United States are the ICD-10 (International Classification of Diseases, 10th Revision) and CPT (Current Procedural Terminology) codes. Staying updated with changes in these systems is critical for healthcare providers and billing professionals alike. That’s why working with a professional medical billing company like Thrive Medical Billing is invaluable.

In this article, we will explore what ICD-10 and CPT codes are, how recent updates impact medical billing, and why keeping up with coding changes is crucial to your practice’s financial and legal success.

What Are ICD-10 and CPT Codes?

ICD-10 Codes

ICD-10 codes are managed by the World Health Organization (WHO) and adapted in the U.S. by the Centers for Medicare & Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). These codes classify diseases, symptoms, injuries, and other health-related conditions. They are primarily used for diagnosis coding and play a critical role in public health reporting, clinical research, and insurance reimbursement.

CPT Codes

CPT codes are maintained by the American Medical Association (AMA) and are used to document medical, surgical, and diagnostic procedures and services. These codes are essential in communicating the type of services provided during a patient encounter for billing purposes.

Together, ICD-10 and CPT codes enable accurate billing and reimbursement. A mismatch or outdated usage of either code type can result in claim denials or delays.

Why Do Code Updates Matter?

Healthcare coding is not static. Every year, CMS and AMA release updates to reflect changes in medical knowledge, technology, and healthcare delivery. These updates may include:

• New codes for newly recognized conditions or procedures
• Revisions to existing codes to provide greater specificity
• Deletions of outdated or redundant codes
• Guideline modifications for documentation and usage

Failing to keep up with these changes can lead to costly errors in billing and even compliance violations. That’s where a reliable medical billing company like Thrive Medical Billing proves its value by staying on top of every update and ensuring correct usage across the board.

2025 ICD-10 Code Updates: Key Highlights

The latest ICD-10-CM updates, effective October 1, 2024 (for fiscal year 2025), brought numerous changes. Below are some highlights:

1. Expansion of Mental Health Diagnoses

Several new codes were added to reflect growing awareness of mental health conditions. For instance:

• New codes for prolonged grief disorder
• Additional specificity for depressive episodes in children and adolescents

2. Enhanced Coding for Social Determinants of Health (SDOH)

To align with value-based care initiatives, new Z codes were introduced for capturing non-medical factors affecting patient health, such as housing insecurity, employment status, and social isolation.

3. Updates in Cardiology and Oncology

New codes now provide more detailed classifications for conditions like chronic ischemic heart disease and specific types of lymphoma, improving diagnostic accuracy and reimbursement tracking.

At Thrive Medical Billing, our team meticulously reviews these updates and integrates them into the billing process for every specialty we serve.

2025 CPT Code Updates: What’s New?

The CPT code updates for 2025, which went into effect January 1, include several significant changes:

1. New Technology and Remote Services

Reflecting the boom in digital health, multiple new CPT codes were added for:

• Remote therapeutic monitoring (RTM)
• AI-assisted diagnostics
• Digital therapeutics

These additions allow providers to be reimbursed for technology-driven patient care innovations.

2. Preventive and Screening Services

To support early diagnosis, updates were made to codes related to cancer screenings, immunizations, and wellness checks. This includes enhanced codes for genetic screening and expanded age ranges for vaccine codes.

3. Surgical Procedure Revisions

Certain surgical procedure codes have been updated for clarity and specificity, including orthopedic and neurosurgical interventions. These changes improve documentation and reduce claim disputes.

At Thrive Medical Billing, we not only update our systems with these changes but also educate our clients on how to document services correctly for optimal billing outcomes.

Consequences of Using Outdated Codes

Using outdated or incorrect ICD-10 or CPT codes can have serious consequences for healthcare providers:

• Claim Denials: Payers will reject claims with invalid or obsolete codes.
• Delayed Payments: Corrections and resubmissions slow down cash flow.
• Compliance Risks: Repeated coding errors may trigger audits and penalties.
• Patient Care Impact: Incorrect coding can lead to misleading medical records and treatment plans.

To avoid these risks, partnering with a certified medical billing company like Thrive Medical Billing ensures that your claims are clean, accurate, and up to date.

How Thrive Medical Billing Helps You Stay Compliant

1. Real-Time Code Integration

We update our billing software as soon as CMS and AMA release new ICD-10 and CPT codes. Our automated systems flag any outdated codes before submission, reducing errors and claim denials.

2. Certified Coders and Auditors

Our team includes AAPC- and AHIMA-certified coders who are experts in multiple specialties. We also employ compliance auditors who ensure every claim is thoroughly reviewed.

3. Specialty-Specific Expertise

Whether you're a cardiologist, psychiatrist, or orthopedic surgeon, Thrive Medical Billing tailors code updates and documentation support to fit your specialty. This ensures accurate billing and maximum reimbursement.

4. Staff Education and Support

We regularly provide clients with easy-to-understand updates on new codes, along with documentation tips and best practices. We offer webinars, cheat sheets, and one-on-one support to help your team stay informed.

5. Proactive Claims Management

If new codes result in payer pushback or unexpected denials, our team quickly intervenes, corrects the issue, and resubmits claims—keeping your revenue cycle moving smoothly.

Best Practices for Adapting to Code Updates

Even with expert help, healthcare providers should adopt certain best practices to make the most of coding changes:

• Review Annual Updates: Familiarize yourself with code changes relevant to your specialty.
• Train Your Team: Ensure that staff members who assist with documentation are aware of the new requirements.
• Use Documentation Templates: Update your EHR templates to reflect new coding guidelines.
• Audit Regularly: Conduct routine internal audits to catch coding discrepancies.
• Partner with Professionals: Let a trusted medical billing company like Thrive Medical Billing handle the coding complexities while you focus on patient care.

Looking Ahead: Future Trends in Medical Coding

As healthcare evolves, so will the complexity and capabilities of ICD and CPT coding systems. Key trends on the horizon include:

• Greater integration of AI in coding assistance
• More granular codes for personalized medicine and genomics
• Continued expansion of telehealth and remote care codes
• Increased emphasis on social and behavioral health coding

Thrive Medical Billing is committed to staying ahead of these trends to keep our clients compliant, efficient, and competitive.

Final Thoughts

Keeping up with ICD-10 and CPT code updates is not just a matter of administrative efficiency—it’s a legal and financial necessity. Failing to do so can lead to claim rejections, compliance issues, and loss of revenue.

Working with an experienced medical billing company like Thrive Medical Billing eliminates the stress and guesswork. We ensure that your practice stays current with every coding change, maintains compliance, and maximizes reimbursements—all while allowing you to focus on what you do best: providing exceptional patient care.

Let Thrive Medical Billing be your trusted partner in navigating the ever-changing world of healthcare coding. With our expertise, your billing will always be precise, compliant, and profitable.