What’s New In Icd-10-cm And Icd-10-pcs? A Must-read For Coders And Providers

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Did you know that ICD-10 codes undergo annual updates that directly impact hospitals, coders, and healthcare providers? More than just lists of diagnostic and procedural codes, ICD-10-CM and ICD-10-PCS are structured systems that determine how patient conditions and treatments are documented, billed, and reimbursed. ICD-10-CM ensures diagnostic accuracy, while ICD-10-PCS captures detailed insights on inpatient procedures. Together, they not only streamline claims and reimbursement but also enhance compliance, research, and public health reporting.
With the pace of medical billing and coding innovation and emerging health challenges, the Centers for Disease Control and Prevention (CDC) and the Centers for Medicare & Medicaid Services (CMS) update these codes annually to reflect current clinical practice. The FY 2026 ICD-10-CM and ICD-10-PCS updates, effective from October 1, 2025, through September 30, 2026, bring significant revisions that providers must understand to stay compliant and avoid denials.

ICD-10-CM FY 2026 Key Changes
1. New, Deleted, and Revised Codes
The FY 2026 ICD-10-CM set introduces ...
... 487 new diagnosis codes, eliminates 28 outdated ones, and revises 38 existing code descriptions. These refinements improve coding precision, boosting both claims accuracy and reimbursement outcomes.
2. Guideline Updates
The official guidelines have also been revised. Notable updates include:
• HIV Coding Guidance – Adjustments to sequencing and reporting rules for B20, Z21, R75, and related codes (see Section I.C.1.a.2).
• Diabetes in Remission – A new guideline for Type 2 Diabetes Mellitus in Remission (E11.A), clarifying documentation and coding standards.
3. Alphabetic Index & Tabular List Edits
Numerous entries have been corrected or reclassified to reduce ambiguity and enhance accuracy in code assignment. Spelling corrections, cross-reference fixes, and sequencing note clarifications support consistency.
4. Expanded Clinical Specificity by Chapter
Updates span several chapters, including:
• Chapter 4 (Endocrine, Nutritional, Metabolic Disorders): Expanded detail for hyperoxaluria, familial hypercholesterolemia, and diabetes remission.
• Chapter 6 (Nervous System): New multiple sclerosis subtype codes.
• Chapter 7 (Eye and Adnexa): Refinements for laterality and inflammatory conditions.
• Chapter 12 (Skin): New chronic ulcer codes specifying severity, site, and laterality.
• Chapter 17 (Congenital Malformations): New codes for rare syndromes and genetic disorders.
• Chapter 19 (Injury & External Causes): Expanded injury, poisoning, and exposure-related codes.
5. POA Exempt Codes and Conversion Tables
The Present on Admission (POA) list has been revised to reflect clinical practice, and CMS has released updated conversion tables to help providers transition seamlessly.

ICD-10-PCS FY 2026 Key Changes
1. New, Deleted, and Revised Codes
The FY 2026 ICD-10-PCS set includes 156 new procedure codes, 27 deletions, and a small number of revised entries. These changes expand documentation for surgeries, implants, and advanced treatment methods.
2. Guideline Updates
• Expanded New Technology coding rules (E.1a, E.1b) with updated examples.
• Clarifications for root operation definitions and examples, improving coding for complex surgical procedures.
3. Alphabetic Index Updates
Numerous corrections were made to improve anatomical accuracy, including directing the term “Cricoid cartilage” to the Larynx rather than the Trachea. Updates also fix misclassified terms and cross-references.
4. Table Updates
The Medical and Surgical section has new codes for procedures involving the dura mater and spinal meninges. The New Technology section adds device and substance values to reflect medical innovation.
5. Examples of New PCS Codes
Some notable additions include:
• 00W20KZ – Revision of nonautologous tissue substitute in dura mater, open approach.
• 03120JY – Bypass of innominate artery using synthetic substitute, open approach.
• 09XL0Z3 – Transfer of nasal turbinate to sphenoid bone, open approach.
• 0RRJ008 – Reverse ball-and-socket prosthesis for right shoulder joint.
• 0SRD07D – Replacement of left knee medial meniscus with autologous tissue substitute.
6. Device and Substance Updates
Additional device values and new substances were introduced in the Introduction (XW) tables within the New Technology section, while outdated categories were retired.
Why These Updates Matter
The FY 2026 ICD-10-CM and ICD-10-PCS changes reflect the need for accurate, detailed, and clinically relevant coding. Providers and coders must carefully review the updated guidelines, participate in training, and reference official resources from CDC and CMS. Healthcare organizations should also strengthen auditing and education programs to minimize compliance risks.
Given the growing complexity of annual updates, many providers are leveraging professional outsourcing medical billing and coding service providers in India to reduce administrative burden, improve compliance, and maintain accuracy. Combining internal staff training with expert outsourcing support ensures a balanced, cost-effective approach.
FAQs
Do the updates affect sequencing rules?
Yes, some chapters include revised sequencing and instructional notes.
Are there new codes for rare conditions?
Yes, including rare genetic disorders such as Kabuki Syndrome and Usher Syndrome.
Do outpatient coders need ICD-10-PCS updates?
No, ICD-10-PCS applies to inpatient settings, though awareness is beneficial.
Are there new Z codes in FY 2026?
Yes, particularly for family history, genetic susceptibility, and social determinants of health (SDOH).
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