FY 2025 Highlights (Effective Oct 1 2024)

• The FY 2025 ICD-10-CM update added 252 new diagnosis codes, deleted 36, and revised 13 code titles.
• Some new codes in genitourinary (GU / urology) diseases (Chapter 14: Diseases of the genitourinary system N00-N99) were added. These fall under urology coding updates and directly affect urology coding guidelines.
• There were also new “in remission” codes for neoplasms (cancers) under the Neoplasm chapter, which may affect urologic cancers, now referred to as remission codes urology.

FY 2026 Coming Changes (Effective Oct 1 2025

• Over 400 new diagnosis codes are being introduced. These include ones that increase specificity in several areas (endocrine, renal / nephropathy ICD-10, etc.).
• In the genitourinary (GU) disease chapter, there are 5 new diagnosis codes expected as part of urology coding updates.
• Specific new urology-related codes:
  1. B-: Acute nephritic syndrome with immune complex membranoproliferative glomerulonephritis (IC-MPGN). This gives more specificity about the underlying glomerular pathology
  2. B-: Nephrotic syndrome with immune complex membranoproliferative glomerulonephritis. Similar point: more details about the cause/type of nephrotic syndrome
  3. B: Hereditary nephropathy (not elsewhere classified) with APOL1-mediated kidney disease. APOL1 is a genetic risk factor; this helps codify hereditary or genetic kidney disease specifically.
• Also, new code categories around poisoning / adverse effects/underdosing of fluoroquinolone antibiotics. Since fluoroquinolones are commonly used in GU/urinary infections, these new codes on fluoroquinolone adverse effects are highly relevant.

Why These Matters & Where to Watch Out (for Urology Coding)

These updates in medical coding automation have a real impact on urology billing changes and claims. Here are what to watch out for in your documentation/coding to avoid denials:

1. Increased Specificity Required

   • If the provider documents “glomerulonephritis”, try to capture the subtype (immune complex, etc.) if known, because ICD-10 is adding codes for those.
   • For kidney disease, document if it’s hereditary, genetic (e.g. APOL1), or secondary to something.

2. Diagnosis versus Etiology / Cause

   • When coding nephritic/nephrotic syndromes with specific causes (immune complex, etc.), documentation must support that cause (lab, biopsy, genetics) to use the new subcodes directly linked to nephrotic syndrome coding. (for example, N00.B1, N04.B, etc.).
   • Be careful: if cause is suspected but not confirmed, using a more general/nonspecific code may still be necessary — but notice what codes might be invalid or excluded when cause is known, which again ties into urology coding updates.

3. Use of “In remission” Codes in GU Oncology

   • Some urologic cancers may now have remission codes urology. If the chart says “prostate cancer, in remission” or “bladder cancer, in remission,” check whether there’s an applicable remission code rather than a generic history or follow-up code.

4. Antibiotic Complication / Poisoning Codes

   • With the new fluoroquinolone poisoning / adverse effect codes, ensure any adverse reaction to antibiotic therapy is documented clearly: what drug, what reaction, date, etc. That makes the difference between a general adverse effect/side effect vs a codeable poisoning / underdosing event.

5. Exclusion / Inclusion Notes

   • Many of the new codes come with new instructional notes (Excludes1, Excludes2, Use additional code, etc.). These can affect whether two diagnoses can be coded together, or whether a more specific diagnosis must be used instead of a less specific one, as outlined in urology coding guidelines.

6. Timing / Effective Dates

   • The new FY 2026 codes only take effect Oct 1, 2025, so documentation systems, EMRs, and coders must be ready by then. Claims with dates before that must use the old set.

What Changed in 2025 for Urology

• The Conversion Factor for 2025 was decreased by ~2.83%, from $33.2875 to $32.3465.
• Relative Value Units (RVUs) were revised for certain new urology CPT codes (for example, prostate ablation codes 51721, 55881, 55882; bladder neck/prostate procedures 53865, 53866), and supply costs (e.g. iTind device in those procedures) were updated.
• Changes to the cost of cystoscopy “supply packs” and the supply for cleaning/disinfecting endoscopes:
  • The supply pack for cystoscopy: price decreased from $113.70 to $37.63 (with a multiple-year phase-in).
  • The supply pack for cleaning/disinfecting endoscopes saw a 61% increase in price.
• Global surgical package rules: modifiers for certain 90-day global procedures, and a new add-on code (G0559) for post-operative care by a physician who did not perform the surgery.

Approximate Medicare Payments for Urology Procedures

Here are some example payments/trends and guidance on how to find exact figures:

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