AHA Coding Clinic Q3 2025 released went into effect September 1, 2025 and offers new ICD-10-CM/PCS guidance. Important areas questioned this fall are presymptomatic Type 1 diabetes and level codes with hypoglycemia, pediatric versus adult BMI code use, a new specificity for pulmonary embolism, and sequencing of pancytopenia caused by drugs. Here's why it matters: correct code choice increases data quality, denials are less with proper code choice, and claims are less complicated.
Okay, let's analyze it.
What shifted and why you should worry:
1. Release timing:
AHA also approved the Third Quarter 2025 ICD-10-CM/PCS newsletter on September 1st of 2025.
Therefore, the advice is up to date as of your coding, CDI, and billing checks today.
2. Corresponding AHA 2025 priorities:
AHA tools in 2025 still stress presymptomatic Type 1 diabetes coding, use of BMI by age segment, pulmonary embolism variants, and pancytopenia from treatment.
These are repeated concerns through AHA teaching and handbook updates this year, and payer review should be coming.
3. Education credit:
AHA's portal features on-demand quizzes and webinars with CEUs attached to Coding Clinic resources.
Your group can check learning and maintain credentials up to date.
Pro tip: Give this article to providers and your coding lead and then schedule a 30-minute time to synchronize order sets and documentation.
Presymptomatic Type 1 diabetes: use E10.A-series and add level codes from hypoglycemia if documented:
What the ICD-10-CM guidelines say:
FY 2025 added E10.A0, E10.A1, E10.A2 for presymptomatic Type 1 diabetes mellitus.
These codes define early disease before classic symptoms at Stage 1 and Stage 2 of islet autoimmunity and dysglycemia.
The guidelines state outright that they are adding codes E10.A for early T1DM before symptoms.
Correspond with codes of hypoglycemia level as relevant:
FY 2025 also incorporated three "severity" codes for hypoglycemia.
If justified with supporting documentation, report the level:
| Hypoglycemia level | ICD-10-CM code | Clinical cue in references |
|---|---|---|
| Level 1 | E16.A1 | Glucose less than 70 mg/dL alerts patients to avoid severe events |
| Level 2 | E16.A2 | Glucose less than 54 mg/dL, neuroglycopenic range |
| Level 3 | E16.A3 | Severe event needing help from another person |
Report level with diabetes or hypoglycemia codes whenever record justification exists.
These are new codes and "use an additional code for level of hypoglycemia" notes called out in the guidelines and addenda of the FY 2025.
Documentation checklist for providers
- When you order autoantibody testing, specify Stage 1 or Stage 2 if you know.
- When low glucose has occurred in the patient, report glucose value and symptoms and report "Level 1/2/3 hypoglycemia" as clinically justified.
- Connect hypoglycemia to diabetes, treatment, or other causation if known.
Why it benefits billing: Systematic staging and level codes aid risk adjustment and back-and-forth minimization during audits.
BMI Coding: pediatric versus adult rules and where BMI maps onto the claim:
Two age grades with non-homonymous code sets
- Adults: use Z68.1–Z68.45 for BMI values.
- Pediatrics (2–19 years of age): use Z68.51–Z68.54 based on.
- When pregnant: do not send BMI codes.
The FY 2025 official guidelines also instruct coders that BMI may be entered by non-physician clinicians and should always be secondary to a related diagnosis such as obesity.
Summary guide
| Patient group | What to capture | ICD-10-CM range |
|---|---|---|
| Adults 20+ years | Numeric BMI value | Z68.1–Z68.45 |
| Children and adolescents 2–19 years | BMI percentile | Z68.51–Z68.54 |
When you code practice for treatment of individuals with obesity, also code BMI with the 2025 severity codes for obesity (E66.811–E66.813) when you code.
CDC disseminated educational resources outlining the new codes for adult obesity effective October 1, 2024.
Coding note: When graphing BMI, we should use the condition it affirms, i.e., overweight, class 2 obesity, or underweight. It puts BMI in a proper secondary position.
Pulmonary embolism: improved specificity in 2025, with specificity of cement and fat embol:
What's new:
ICD-10-CM 2025 refined several I26 codes and added alternatives to code cement and fat embolism of the pulmonary artery with or without acute cor pulmonale.
There were also descriptor updates to subsubsegmental codes to specify thrombotic emboli. Examples:
- I26.03 Cement embolism of pulmonary artery with acute cor pulmonale
- I26.95 Cement embolism without acute cor pulmonale
- I26.04 Fat embolism with acute cor pulmonale
- I26.96 Fat embolism without acute cor pulmonale
- I26.93 Single subsegmental thrombotic PE without acute cor pulmonale
- I26.94 Multiple subsegmental thrombotic PEs without acute cor pulmonale
AAPC also pointed out these cardiology revisions of the 2025 set and referred to an effective date of October 1, 2024.
How to choose a correct PE code
- Type of embolism: thrombotic, fat, cement, or other.
- Acute cor pulmonale present or absent.
- Extent if subsegmental and whether single or multiple.
- Chronic vs acute as documented.
| Clinical scenario | Documentation cues | Likely category |
|---|---|---|
| Post-vertebroplasty embolic event | “Cement embolism” and cor pulmonale status | I26.03 or I26.95 |
| Trauma patient with fat embolism | “Fat embolism” and cor pulmonale status | I26.04 or I26.96 |
| CT angiogram shows multiple subsegmental PEs | “Multiple subsegmental thrombotic PE,” no cor pulmonale | I26.94 |
| Standard acute thrombotic PE | Cor pulmonale present or absent | I26.0x or I26.9x |
Coding tip: Cardiology and radiology reports should indicate type of embolism and status of cor pulmonale. One sentence may avert coder questioning.
Pancytopenia: Select code from drugs if treatment is causative:
When therapy induces pancytopenia, code the drug-related pancyt
- D61.810 for antineoplastic chemotherapy-induced pancytopenia.
- D61.811 for other drug-induced pancytopenia.
- D61.818 for other pancytopenia when not drug-induced.
Authoritative codes classify such selections under the family of D61.81.
There are also guidelines regarding cases with radioactive agents and other therapies, advocating verification of the causative agent prior and then attachment of the appropriate adverse effect code from T36–T50 as needed.
Practical sequencing
- For treatment of encounters of pancytopenia due to chemotherapy, code report D61.810 and append the drug adverse effect code as per the table.
- If the cause of pancytopenia is non-drug related, choose Select D61.818 and code to underlying condition if known.
- If the encounter is primarily for cancer treatment and pancytopenia is a complication, use the FY 2025 rules of encounter sequencing for encounters primarily for chemo, radiation, or immunotherapy and then sequence complications. Coders base their sequencing off the rules provided through the CMS guidelines.
| Cause | Code | Add secondary codes |
|---|---|---|
| Chemotherapy | D61.810 | Adverse effect code if directed; neoplasm code per guidelines |
| Other drug | D61.811 | Adverse effect code if directed; specify drug |
| Not drug-induced | D61.818 | Underlying cause if documented |
Tables you can paste into your playbook
1. Hypoglycemia levels for add-on use
| Level label | Code | When to add |
|---|---|---|
| Level 1 | E16.A1 | Glucose less than 70 mg/dL and documented “Level 1” or equivalent phrasing |
| Level 2 | E16.A2 | Glucose less than 54 mg/dL |
| Level 3 | E16.A3 | Severe event needing assistance |
2. BMI quick guide
| Patient | You report | Reminders |
|---|---|---|
| Adult 20+ years | Z68.1–Z68.45 | Secondary only; not during pregnancy; can be documented by non-physician clinicians |
| Ages 2–19 years | Z68.51–Z68.54 | Use percentile for age and sex |
3. Pulmonary embolism highlights
| Scenario | Code examples |
|---|---|
| Cement embolism of pulmonary artery | I26.03 with cor pulmonale, I26.95 without |
| Fat embolism of pulmonary artery | I26.04 with cor pulmonale, I26.96 without |
| Subsegmental thrombotic PEs | I26.93 single, I26.94 multiple, both without acute cor pulmonale |
4. Pancytopenia selection
| Etiology | Code |
|---|---|
| Chemo-induced | D61.810 |
| Other drug-induced | D61.811 |
| Not drug-induced | D61.818 |
Documentation tips your docs can use today:
1. Endocrinology and primary care
- Spell out "Presymptomatic Type 1 Diabetes Stage 1/2.
- Assess the severity of the hypoglycemia and the glucose value if you discuss lows.
- When treatment effects induce hypoglycemia, mention the drug.
2. Pediatrics and family practice
- For individuals 2–19 years of age, report BMI percentile and not a number.
- Add the diagnosis that BMI supports, such as overweight or obesity class.
3. Radiology and Cardiology
- Specify in PE impressions the type of embolism and the presence of acute cor pulmonale.
- For subsegmental disease, indicate single or multiple.
4. Oncology, heme, and infusion clinics
- In a three-line cytopenia status post treatment laboratory, report "pancytopenia due to chemotherapy" or "due to [drug]," enabling coders to correctly assign D61.810 or D61.811.
These small phrases prevent denials, and speed claims out the door.
Compliance guardrails to keep in mind:
- Adhere to sequencing guidelines. Your FY 2025 official guidelines outline how often you should lead with therapy encounters, complications, or underlying conditions. Have that PDF handy.
- BMI comes secondary and could be from a non-physician provider, but the corresponding diagnosis should come from the provider.
- These guidelines are permissive of presymptomatic presentations. Utilize E10.A only if the graph supports initial-stage T1DM.
- PE codes no longer distinguish material type or thrombotic detail. Query if report of scan is non-specific.
How this relates to revenue and denials
Neat records and correct codes assist with:
- Complete and accurate severity and risk profiles. Coverage of presymptomatic T1DM and hypoglycemia might modify risk modeling.
- Reduced payer queries. P-compliant PE codes and brief pancytopenia etiology lessen "insufficient detail" denials.
- Smoother audits. BMI standards and record-keeping by other clinicians are right out of the guidelines.
If denials continue to creep in, make provider templates more stringent and insert discrete fields for "Stage 1/2," "Level of Hypoglycemia," "Type of PE," and "Causative medication."
Our experts at Human Medical Billing are available to assist with building and training.
- 1. Inform providers and your lead coder of this revision.
- 2. Modify templates to add hypoglycemia level, type of PE, and pancyt.
- 3. Explore AHA on-demand classes and exams and receive CEUs as you learn.
- 4. Perform a mini audit of recent diabetes, VTE, oncology, and pediatric visits and determine where opportunities were missed.
Future of your practice or hospital
If you desire external assistance, Human Medical Billing offers end-to-end medical billing services and specific medical coding services audits.
Inquire about denial management services, account receivables services, and AI medical billing process optimizations.
Review our success stories, visit the Xpert billing blog page, or go to about us and reach out for a speedy consultation.
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FAQ: You Ask, We Answer
ICD-10-CM added E10.A0, E10.A1, E10.A2 for presymptomatic Type 1 diabetes and created E16.A1–A3 for hypoglycemia levels. Use the level codes when documentation supports them.
For ages 2–19, use Z68.51–Z68.54 based on BMI percentile. For adults, use Z68.1–Z68.45 with the numeric BMI. Do not report BMI during pregnancy.
2025 codes add clarity for cement and fat embolism and refine subsegmental thrombotic PE descriptors. Capture embolism type and cor pulmonale status.
Use D61.810 for chemo-induced and D61.811 for other drugs. If not drug-induced, use D61.818 and link the underlying cause when known.
