This page addresses follow-up questions and additional information pertinent to our webinar
Breaking News: ICD-10-CM Code Updates for 2025.
** The coding information and guidance are valid at the time of publishing. Learners are encouraged to research
subsequent official guidance in the areas associated with the topic as they can change rapidly.

Q:  Ozempic has been in the news a lot for its off-label use as a weight loss medication. If Ozempic is being used for weight loss, should code Z79.85 be reported?
A:  No. Report this code only when Ozempic is being used for diabetes. The code description is specific to injectable antidiabetic medications.

Q:  When coding obesity class, can the coder assign the class based on the patient’s BMI or does it have to be specifically documented?
A:  Haugen Consulting Group recommends only coding obesity class when it is specifically documented since the codes do not have inclusion terms defining the class levels in terms of BMI.

Q:  Why is code S43.43- used to report a Bankart lesion when the code indicates a superior tear and Bankart lesions are inferior tears?
A:  Per Coding Clinic, code S43.43- is correct for reporting a Bankart lesion because it is specific to a tear of the glenoid labrum. The other codes in subcategory S43.4 are specific to other parts of the shoulder joint, such as rotator cuff and coracoacromial ligament.

Q:  How is triple negative breast cancer coded as of October, 1, 2024?
A:  Assign a code from category C50 for the breast cancer along with a code for each type of receptor status: estrogen (Z17.0/Z17.1), progesterone (Z17.2-), and HER2 (Z17.3-).

Q:  I have a question regarding the new ICD-10-CM codes for DDD of the lumbar and lumbosacral spine  with or without discogenic back pain.  Per the ICD-10-CM codebook the back pain may be described as either discogenic or axial back pain (M51.360/M51.362) or no mention of low back pain at all(M51.369):

With these new codes we originally thought “discogenic” back pain had to be documented as such but seeing that they add the word “axial” does this constitute simply “low back pain not further specified”? Axial pain is a common type of low back pain and is usually non-specific.  It is confusing because the wording for M51.369-states without mention of lumbar back pain and does not state “discogenic” or “axial”.  So if a patient has DDD of the lumbar region with low back pain should we be coding M51.360 even though the documentation does not specify discogenic or axial low back pain. It would also feel weird to code M51.369 when patient does have low back pain. Can you please help us understand?
A: If the provider documents axial or discogenic low back pain (LBP) or LBP due to DDD, assign code M51.360 or M51.362. The current indexing and guidelines do not support linking LBP to DDD without physician documentation of a cause-and-effect relationship. This is especially true in patients with multiple back conditions who could also have other causes of LBP. This is an opportunity for CDI to get involved to ensure proper reporting of the condition. Please see the attached information from the March 2023 Coordination and Maintenance Committee Meeting below.

Please know that this is not official advice and we encourage you to submit this question to Coding Clinic for official coding advice.

In the Coordination and Maintenance Committee Meeting Topic Packet from March 2023, the following information was published:

Discogenic Low Back Pain A prior proposal related to this was presented in March 2021 ICD-10 Coordination and Maintenance meeting, titled “Lumbar Degenerative Disc Disease With and Without Pain.” This proposal incorporates changes in response to comments.

Physicians utilize a variety of diagnostic labels which lack granularity with regard to lumbar degenerative disc disease (DDD) associated with either midline axial or sclerotomal, non- radicular/non-sciatic referred leg pain. The presence or absence of pain associated with degenerative disc disease in the low back is an important factor in clinical decision making in regard to selecting the appropriate treatment.

Pain may present in the low back, or may be referred to the lower extremity, or both as a result of lumbar discogenic disease. Symptomatic lumbar discogenic disease represents an increasingly large burden to the health care system.

In addition, absence of pain is generally a sign that the degenerative disc disease is non-noxious. Lumbar disc degeneration also is not a definitive diagnosis as it only represents at most a morphologic sub-grade of disc degeneration by the most widely known T2-based Pfirrmann grading scoring tool available for MRI survey interpretation of the lumbar spine. MRI has provided a paradigm shift in how lumbar spine pathology is managed; the diagnosis of DDD predates MRI and was originally based on X-ray. Treatment expectations have evolved with our understanding of provocative discography and MRI. Restorative/regenerative treatment measures address dark discs, Pfirrman grades 3-7 out of 8 grades. Lumbar disc degeneration may, however, advance further via atraumatic or traumatic mechanisms from fissuring or bulging to a displaced disc herniation and/or stenosis. Later treatment options for lumbar disc herniation and/or stenosis include surgical decompression to address herniation-induced dermatomal radiculopathy/sciatica and stenosis-induced myelopathy. The degeneration process is a cascade, not a stable, static snapshot but rather a developing, dynamic changing presentation.

Back pain location can be described by region. Expansion of coding for the purposes of this proposal are limited to the lumbar region as MRI Pfirrmann grades are confined to the lumbar spine only and thus major advances in spine care have mostly targeted treatment in the lumbar spine. Sciatica has come to mean dermatomal or radicular leg pain and may be differentiated from nociceptive/referred (sclerotomal)/non-radicular pain by exam. That is to say that radiculopathy is diagnosed clinically by a positive straight leg raise, Lasegue’s sign, crossed Lasegue’s sign, positive bowstring, positive femoral stretch test and motor/sensory/reflex change. Symptomatic lumbar discogenic disease is diagnosed clinically by axial midline back pain, pain with flexion, sitting intolerance, positive provocative with sustained hip flexion and absence of motor/sensory/reflex change and positive discography.

Chronic low back pain (CLBP) or lumbago has 6 sources including: (1) discogenic; (2) facetogenic; (3) neurocompressive including herniation and stenosis; (4) sacro-iliac; (5) vertebrogenic; and (6) psychogenic. The predominant source of CLBP is discogenic low back pain (DLBP). DLBP represents 30-50% of CLBP, versus facet joint pain ~31%, sacroiliac joint pain ~18% and other sources ~8%1,2.

Discogenic back pain associated with DDD can be multifactorial and difficult to treat. The type of pain present and whether it is primarily LBP or leg pain or both is an important component of the clinical assessment. Treatments for discogenic back pain have ranged from anti-inflammatory medications to invasive procedures including spinal fusion and spinal arthroplasty. There has also been a growing interest in developing strategies that aim to repair the degenerative disc biologically, or to supplement tissue lost to degenerative disc disease3-7.

ISASS requests updated ICD-10-CM codes that enable the identification of pain present with lumbar and lumbosacral degenerative disc disease and enable the pain to be characterized as involving either the lumbar region only (axial), the lower extremity only, or both, which will be of benefit for distinguishing, tracking, and improving algorithms and treatments for this common and important clinical issue.

For a deeper dive into the complete changes for 2025, visit the CMS website: https://www.cms.gov/medicare/coding-billing/icd-10-codes/2025-icd-10-cm

Looking for additional information on this topic?