ICD-10-CM Expert for Physicians 2025

The Official Guidelines for Coding and Reporting for 2025 are bound into this book. This code book contains the complete updated 2025 code set along with updated guidelines.

The ICD-10-CM Expert for Physicians 2025, with Optum’s hallmark features and format, makes facing the challenge of accurate diagnosis coding easier. Developed specifically to meet the needs of physicians, the Optum Expert ICD-10-CM code book contains the complete diagnosis code set, which is the cornerstone for establishing medical necessity, determining coverage, and ensuring appropriate reimbursement. Also included are the 2025 ICD-10-CM Official Guidelines for Coding and Reporting, with chapter-specific guidelines and examples in the tabular section. The familiar Optum symbols identify codes associated with CMS quality payment program (QPP) measures and CMS hierarchical condition categories (HCC) used in risk adjustment (RA) coding and more.

Latest updates to Professional and Expert editions of 2025 ICD-10-CM for Physicians:

• NEW — Optum Edge — Intuitive features and format. Visual alerts, including color-coding and symbols that identify coding notes and instructions, additional character requirements, placeholder X, Medicare Code Edits (MCE), manifestation codes, QPP, HCCs, unspecified codes, and more.
• NEW — Optum Edge — Icons for April updates. Easily distinguish between April and October new and revised codes with green icons for April and black for October changes.
• NEW — Optum Edge — Expanded Table of Drugs and Chemicals. Expanded to include updated drugs and codes listed with associated intent with icon to easily identify the added drugs.
• NEW — Optum Edge — Icons identifying RxHCCs and ESRD HCCs. Quickly identify the RxHCC and ESRD/PACE ICD-10-CM codes used in risk adjustment coding by Medicare Advantage Plans.
• NEW — Optum Edge — Icons identifying HHS-HCCs.  Easily identify the Department of Health and Human Services HHS-HCCs used by commercial insurance companies.

Key features and benefits of this ICD10 code book:

• Product Updates. April and other ICD-10-CM changes and updates will be made available online.
• Updated coding tips.  Coding tips are reviewed and updated, and assist in appropriate code selection.
• Clinical definitions. Clinical definitions have been added for a better understanding of complex ICD-10-CM diagnostic terms.
• List of code changes and conversion table. A list of all 2025 new, revised, and deleted codes to identify at a glance code changes for your specialty. Plus an ICD-10-CM conversion table from the new and changed codes to the code previously used.
• Updated index with shaded guides. The updated Index to Diseases and Injuries includes vertical shaded guides that show the indent levels for subentries under main terms.
• Guidelines with coding examples. Official Guidelines for Coding and Reporting including chapter-specific coding examples.
• Helpful illustrations. Detailed color anatomy illustration appendix. Plus, many illustrations at the code level identifying specific code-related anatomy.
• Supplementary appendixes. Pharmacology listings, Z codes for long-term use of drugs and associated drug names, and Z codes used only as primary diagnosis.

Additional enhancements found in Professional and Expert for Physicians:

• Complete list of new revised and deleted codes
• Conversion table identifying new codes
• Coding Tips specific physician and outpatient settings
• Introducing a new symbol in the tabular to identify diagnosis codes associated with QPP measures
• More definitions added for diagnostic terms

What is the difference between the Expert and Professional editions?

• Expert Edition: Spiral bound and appendixes which include: POA coding and reporting tutorial; pharmacology listings of common drugs with therapeutic classes and indications; and code lists for CC, MCC and PDx CC/MCC.
• Expert Edition: Downloadable files for CC Excludes PDx collection, POA exempt codes.
• The Professional edition does not include the above features.