Current Trends in Healthcare That Will Affect RCM: New Findings and Persistent Coding Issues in 2025
Current Trends in Healthcare That Will Affect RCM: New Findings and Persistent Coding Issues in 2025
Our 2025 coding audits have revealed an interesting trend: While we often focus on new and emerging medical coding trends, many of the current coding issues stem from fundamental concepts that require renewed attention. This analysis serves as both a refresher on critical coding basics and a spotlight on areas where experienced coders may benefit from returning to foundational guidelines.
Fundamental Current Trends in Healthcare Requiring Renewed Focus
Injury Code Documentation: Back to Basics
Our 2025 audits have revealed a significant trend in injury code misassignment, particularly regarding the crucial 7th character. The ICD-10 Official Guidelines for Coding and Reporting provide specific instructions for 7th character assignment:
- “A” (initial encounter) is used while the patient is receiving active treatment for the injury. Active treatment includes:
- Surgical treatment
- Emergency department encounter
- Evaluation and continuing treatment by the same or different physician
- “D” (subsequent encounter) is used for encounters after the patient has completed active treatment and is receiving routine care during the healing or recovery phase. This includes:
- Cast change or removal
- Removal of external or internal fixation device
- Medication adjustment
- Suture Removal
- “S” (sequela) is used for complications or conditions that arise as a direct result of an injury.
Cancer Coding: Navigating the Neoplasm Table
The challenges we’re seeing with cancer coding aren’t due to new guidelines but rather to the underutilization of basic coding tools, particularly the ICD-10-CM Neoplasm Table. This essential resource, present since ICD-10’s implementation, continues to be underused or incorrectly navigated.
Refresher on Using the ICD-10-CM Neoplasm Table:
- Start with the anatomical site.
- Review all columns for the appropriate type:
- Malignant, primary
- Malignant, secondary
- Ca in situ
- Benign
- Uncertain behavior
- Always verify the code in the Tabular List.
- Read all instructional notes.
Mental Health Documentation: Increasing Complexity
The landscape of mental health coding has become increasingly nuanced in 2025. Our audits identified a pattern of using unspecified codes when documentation supported greater specificity. Coders should review the significant Mental Health Coding Clinics from 2021, particularly:
- First Quarter 2021: Clarification on coding anxiety with depression
- Third Quarter 2021: Guidelines for coding substance use disorders
- Fourth Quarter 2021: Updates on coding behavioral disturbances in dementia
These Coding Clinics provide essential guidance that directly impacts current coding practices. For instance, we found multiple cases where F41.9 (Anxiety disorder, unspecified) was used when documentation supported F41.1 (Generalized anxiety disorder), demonstrating a need to review these foundational guidelines.
Persistent Medical Coding Trends & Challenges Between 2024-2025
The following findings are similar to those we identified in FY 2024:
Diabetes Mellitus: Complex Relationships
While “with” relationships in diabetes coding were highlighted in 2024, our 2025 audits show this remains a significant challenge. Common errors include:
- Missing diabetic manifestations clearly documented in the record.
- Failing to link diabetic complications when the causal relationship is presumed.
- Not using combination codes when appropriate.
In one audit example, the original code reported was E11.9 (Type 2 diabetes without complications). After our audit findings, the reported code was updated to E11.22 (Type 2 diabetes with diabetic chronic kidney disease). The documentation showed both conditions, but coders missed the presumed relationship per I.A.15 guidelines.
Hypertensive Disease: Combination Coding
The complexity of hypertension coding continues to challenge coders in 2025. Our audits revealed numerous instances where I10 (Essential hypertension) was used when combination codes were required. The ICD-10 Official Guidelines for Coding and Reporting explicitly state that combination codes must be used when the causal relationship is documented.
Need Help Preventing Coding Errors?
As we progress through 2025, successful coding requires attention to these detailed guidelines and careful review of documentation. The evolution of current trends in healthcare and challenges demonstrates the need for continuous education and careful application of coding guidelines, particularly in areas showing persistent errors.
Staying current with the latest ICD-10 guidelines is essential for both individual coders and corporate teams. Our comprehensive coding education programs are designed to enhance accuracy, ensure compliance, and support ongoing professional development. Explore our specialized training bundles for individual learners and corporate teams to advance your coding expertise today.
Beyond education, our coding support and auditing services provide health systems with the expertise needed to navigate complex coding updates. Our experts conduct in-depth audits to identify coding accuracy gaps, reimbursement risks, and areas where additional training is needed. Partner with us to enhance your coding operations and achieve long-term success.
