ICD-10-CM coding updates occur at least annually with the fiscal year changes beginning October 1 of each year. This year’s updates include 487 additions, 28 deletions and 38 revised codes to total 74,719 codes for FY 2026.
Among the new codes is E11.A, Type 2 diabetes mellitus without complications, in remission. This new code comes with corresponding guidance that the code be used “based on provider documentation that the diabetes is in remission.” If documentation is unclear as to whether or not diabetes has achieved remission, the provider would need to be queried for clarification.
Another substantial change is noted in the Multiple Sclerosis category at G35. This code is obsolete beginning October 1, as the category has been expanded with 8 new codes to show if MS is relapsing-remitting, primary or secondary progressive, active and non-active or unspecified. If you have patients with MS on service this month who are still on service October 1, you will need to update coding on your claims due to this change.
The 2026 code set updates include several new and revised wound and injury codes to the flank area. Codes that identify abscesses, cellulitis and other types of skin lesions and wounds were revised to now identify the back as a location. New codes were added to identify the flank area location for lesions and wounds as well.
We also note numerous code additions in the non-pressure chronic ulcer categories to now include ulcers and severity codes to the abdomen, chest, neck, face, groin, upper arm, forearm, and hand. The arm and hand codes are further broken down by laterality – left or right – with severity per location.
Codes for unspecified fractures of wrist and hand were revised to now include separate fracture codes for unspecified fractures of the hand as well as for the wrist.
New codes were added to show poisoning by, adverse effects of, and underdosing of fluoroquinolone (flor-o-quin-o-lone) antibiotics. This class of antibiotics includes Cipro and Levaquin, among others, which have been associated with sometimes permanent side effects involving tendons, muscles, joints, and the nervous system.
New diagnoses were added at T78.07- for intolerances and reactions to milk and dairy products, eggs, and other food reactions with associated severity specifications.
In the Z code category, new codes for genetic susceptibility to certain cancers were added and codes for prophylactic surgery for known genetic risk factors.
The Z code for financial insecurity, Z59.86 has been deleted and the category expanded to include a code for difficulty paying for utilities, other financial insecurity, and unspecified financial insecurity. These Z codes may be assigned based on the visiting clinician’s documentation in the absence of provider documentation of financial insecurity according to coding guidance.
You will want to ensure that your staff are aware of and updated on changes to the code set prior to October 1 so that documentation is available and correct for code assignment.
Claims that have date of service October 1, 2025, or after will need to use the updated code set. Use of deleted or revised codes on claims with 10.01.25 dates of service will Return to Provider (RTP) for correction and delay payment.
The new and changed codes in the FY 2026 code set have been assigned to PDGM groupers and comorbidity adjustment lists, if applicable, which could also impact HIPPS code assignment and payment on and after October 1.
HPS will host an Alliance webinar on September 11 to cover all code set changes for fiscal year 2026 with related guidelines and conventions for using the new and revised codes. To register for our HPS Alliance Exclusive webinar “ICD-10 Coding Update: New Codes & Claims Issues”, click here.
HPS is ready to support you in any way regarding your coding needs. If you require any assistance, please feel free to reach out to us.
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