Promote Revenue Integrity with the FY 2026 ICD-10-CM/PCS Code Updates

October is an important month in healthcare revenue cycle management as it’s when a whole host of ICD-10-CM and ICD-10-PCS code updates take effect. For fiscal year (FY) 2026, ICD-10-CM updates include 487 new diagnosis codes, 38 revised diagnosis codes, and 28 deleted diagnosis codes. The updated ICD-10-PCS code set includes 156 new procedure codes, 27 deleted procedure codes, and four new procedure tables. 

It’s a lot of information to digest. However, thoroughly reviewing and understanding the changes is critical to your reimbursement process and bottom line. 

Diving into FY 2026 ICD-10-CM code changes
The full list of new diagnosis codes is extensive so be sure to check out Table 6A in the FY 2026 IPPS Final Rule. With that said, about half (i.e., 213) of the new ICD-10-CM codes for FY 2026 are in Chapter 19 (Injury, poisoning, and certain other consequences of external causes, S00-T88), adding greater anatomical specificity and/or laterality for injuries like contusions, lacerations, puncture wounds, and open bites.

Chapter 19 also includes a whole host of new diagnosis codes related to poisoning by, adverse effect of, and underdosing of fluoroquinolone antibiotics; toxic effect of xylazine; anaphylactic reactions due to food; and other adverse food reactions.

Chapter 19 also includes a new diagnosis code for Gulf War illness (i.e., T75.830) that the U.S Department of Veterans Affairs describes as “a cluster of medically unexplained chronic symptoms that can include fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems” affecting Gulf War veterans.

The second largest majority of diagnosis code changes are in Chapter 12 (Diseases of the Skin and Subcutaneous Tissue, L00-L99) where 116 new codes add greater specificity for anatomical location, depth, staging, and laterality of non-pressure chronic ulcers.

There are plenty of other diagnosis code changes as well. For example, there’s a new diagnosis code in Chapter 4 (Endocrine, nutritional and metabolic diseases, E00-E89) for Type 2 diabetes mellitus without complications in remission (i.e., E11.A). In Chapter 2 (Neoplasms), there are three new diagnosis codes for malignant inflammatory breast neoplasm (i.e., C50.A0-C50.A2). Similarly, in Chapter 18 (Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified, R00-R99), there’s a new diagnosis code for cannabis hyperemesis syndrome (i.e., R11.16), which involves vomiting and nausea in long-term cannabis users.

In Chapter 21 (Factors influencing health status and contact with health services, Z00-Z99), there are new diagnosis codes for financial insecurity (e.g., Z59.861 for difficulty paying for utilities), genetic susceptibility to disease (e.g., Z15.05 for susceptibility to malignant neoplasm of fallopian tube[s]), and encounters for prophylactic surgery (e.g., Z40.81 for prophylactic surgery for removal of ovary[s] for persons without known genetic/familial risk factors). There are also several new diagnosis codes for personal and family history, personal risk factors, and more.

All the chapters in ICD-10-CM include some degree of changes except for Chapters 8 (Diseases of the ear and mastoid process, H60-H95) and 22 (Codes for special purposes, U00-U85).

Many of the revised ICD-10-CM codes were previously unspecified diagnosis codes that now include greater specificity and additional clinical information. To view the complete list of revised diagnosis code titles, check out Table 6E in the FY 2026 IPPS Final Rule.

Similarly, the 28 deleted codes in the FY2026 update are replaced by more specific diagnosis codes. To view the complete list of invalid (deleted) diagnosis codes, check out Table 6C in the FY 2026 IPPS Final Rule. For example, code G35 (multiple sclerosis) is an invalid diagnosis code because the following codes replace it:

• G35.A: Relapsing-remitting multiple sclerosis

• G35.B0: Primary progressive multiple sclerosis, unspecified

• G35.B1: Active primary progressive multiple sclerosis

• G35.B2: Non-active primary progressive multiple sclerosis

• G35.C0:  Secondary progressive multiple sclerosis, unspecified

• G35.C1: Active secondary progressive multiple sclerosis

• G35.C2: Non-active secondary progressive multiple sclerosis

• G35.D: Multiple sclerosis, unspecified

You can also view information about CC/MCC updates, MS-DRG updates, new technology add-on payments, and more in the FY 2026 IPPS Final Rule tables.

Understanding ICD-10-PCS code updates
With the FY 2026 ICD-10-PCS code update, there are a total of 78,986 procedure codes now available for discharges occurring from October 1, 2025, through September 30, 2026. The new procedure codes and tables cover a range of procedures, and you can view the entire list by downloading Table 6B in the FY 2026 IPPS Final Rule. For example, there are new body part characters in Table 00P for Removal and table 00W for revision of substitutes in the dura mater or spinal meninges. There is a new qualifier character in Table 031 for bypass of innominate artery to an upper artery. Similarly, there is a new table for transfer procedures involving the nasal system and a new table for bypass procedures involving the larynx.

Looking for information on revised and deleted ICD-10-PCS codes? Check out Tables 6F and 6D respectively, both of which are in the FY 2026 IPPS Final Rule.

Reviewing the official coding guidelines
As you review the ICD-10-CM/PCS code updates, be sure to review the most updated coding guidelines as well. Here’s a link to the ICD-10-PCS guidelines and one to the ICD-10-CM guidelines as well.

Looking ahead
The following steps can help organizations leverage the code changes most effectively:

• Avoid unspecified codes. Many of the code revisions and new codes no longer include options for unspecified information. This is particularly true for ulcers, injury depth, and laterality. Provider education and following best practices for coding will be critical.

• Keep an eye on key performance indicators (KPI). Monitoring revenue cycle KPIs is always important—especially after major coding updates.

• Monitor payer policies. Increased specificity can affect coverage, auditing, and claims processing.

• Update EHRs. Ensure systems include the latest updates to avoid claim denials.

Reviewing the FY 2026 ICD-10-CM and ICD-10-PCS changes assists healthcare organizations in minimizing inpatient coding errors, managing denials, and supporting revenue integrity. The ICD-10 code update enables organizations to collect more detailed information and use data analytics for patient care improvement.