If you missed the Harmony Healthcare sponsored webinar on the 2026 fiscal year (FY2026) ICD-10-CM/PCS updates, here we’ll summarize the key points
There are a number of changes that are in the chapter-specific guidelines that address coding for HIV. A brand-new guideline was unveiled about coding for type 2 diabetes that is in remission with a new code E11.A . Coding for multiple sites was clarified with two new guidelines. The prophylactic surgery guideline for malignancy was expanded to include Z40.8 for other prophylactic surgery. Coding professionals should review the entirety of the 2026 guideline changes to be sure that they are able to employ the changes come October 1. ICD-10-PCS guideline changes for FY2026 only occur for the New Technology section and only update the examples provided for guidelines E1.a and E1.b.
At the ICD-10-CM category for breast cancer (C50), a new series of codes was inserted to capture inflammatory malignant neoplasms of the breasts (C50.A-).
Subcategory Code Changes
Codes at the expanded subcategory, E72.53 primary hyperoxaluria, now allow specificity of the type of hyperoxaluria. The three new codes are all considered complication and comorbidity (CCs). This condition is a rare, inherited disorder whereby the body produces too much oxalate, which is a substance that can cause the formation of kidney stones. There is also an expansion of codes for secondary hyperoxaluria depending on the underlying cause of the condition. However, none of those codes are CCs.
Subcategory E83.82 for disorders of pyrophosphate metabolism was expanded. Again, several of those new codes will qualify as CCs. It will be important for providers to document the specific deficiency responsible for the pyrophosphate metabolism disorder so the appropriate code can be assigned.
Subcategory I27.8 for Fontan-related conditions was expanded with one of the codes, I27.840 Fontan-associated liver disease, now identified as a CC. This condition can occur following a Fontan procedure to correct congenital hypoplastic left heart syndrome. Liver cell damage, such as scarring or fibrosis, can occur due to the increased pressure in the liver resulting from a continuous flow of blood through the liver.
Multiple Sclerosis (MS) Code Changes
MS coding has also undergone a drastic revision. The code G35 has been expanded to include the type of MS that the patient has. While none of these codes are identified as CCs or Major Complication and Comorbidity (MCCs), it’s vitally important for research that coding professionals provide this level of detail when assigning MS codes. Clinical documentation integrity specialists should be alerted to provide education to physicians on documenting the specificity of MS when it’s known.
Flank/Abdomen Code Changes
Many of the code changes revolve around the addition of “flank” as its own body part rather than being lumped in with “abdomen”. Flank is the area on the side of the body between the ribs to the hip. Now, from diseases such as cellulitis, acute lymphangitis, and cutaneous abscess (all CCs) to pain and tenderness, flank can be identified as the location of the condition. The expansion to include flank also impacts superficial and open wound injury codes. Open wounds of the flank that penetrate the peritoneal cavity are all MCCs.
ICD-10-PCS Code Changes
Now, switching to ICD-10-PCS, we have already discussed the minimal guideline changes for PCS early in the blog. PCS accuracy requires us to keep up with changes not only to the codes, but to the references that may have been updated. For October 1st, coding professionals are directed to use the occipital bone for procedures involving the clivus. This change is reflected in the new table, 09X, for the transfer of ear, nose, and sinus. It facilitates the coding for nasoseptal flaps (NSF). Also, the cricoid cartilage or cricothyroid membrane is now to be considered as part of the body part “larynx” rather than the “trachea”. This allows specific coding for a cricothyroidotomy procedure and distinguishes it from a tracheostomy.
Additional Code Changes
- Another large expansion of codes occurred at the non-pressure chronic ulcer subcategories L98.4 and L98.A. More specific areas canto be captured with these codes, as well as the depth of the ulcer.
- Acute nephritic syndrome has expanded N00 to identify when this condition is with idiopathic or secondary immune membranoproliferative glomerulonephritis (IC-MPGN). Both of the new codes, N00.B1 and N00.B2 are considered MCCs.
- New genetic disorder codes will be found in the Q87, Q89, Q99, and QA0 categories with many considered as CCs. Again, the specificity of the condition is of great important not only for reimbursement but also, as these codes are used for research purposes.
- Codes for pelvic pain expanded to captured laterality and now also include an option to code suprapubic pain. Costovertebral angle (CVA) tenderness now has its own set of codes. Tenderness occurring at the CVA may indicate the patient has a kidney condition (infection or stones) since it’s an area on the back between the 12th rib and the vertebral column situated over the kidneys.
- Genetic susceptibility, prophylactic surgery, and family/personal history codes all underwent some additions. No code changes impacted social determinants of health, but several codes do have new inclusion terms added.
- There is a new Qualifier in table 0RR, replacement upper joints, to permit the assignment of subscapularis-sparing shoulder replacement. This procedure has a faster recovery period than a traditional full subscapularis detachment.
- Codes for cerebral embolic filtration were moved from the New Technology section into the 5A0 table. Qualifiers allow for the distinction between single, dual, single defection, or extracorporeal flow reversal circuit. There is a new code in New Technology, X2A(H, J, K, L)34B with the Device/Substance/Technology character four assigned for the use of a cerebral embolic filtration, single integrated distal filter.
- New technology codes for October 1st carry the Qualifier B for New Technology Group 11. One of those new codes is X05233B, which captures the code for radiofrequency ablation of the cardiac plexus used to treat pulmonary hypertension.
- New code X28F3WB is for the radiofrequency energy leaflet laceration that is used in combination with an aortic valve-in-valve replacement. This divides the leaflets (native or bioprosthetic), which might otherwise cause a coronary vessel occlusion.
- There is also a New Technology code XXA539B which is for the filtration of Ticagrelor (Brilinta) from a patient’s blood. This extracorporeal circuit is used once per patient and predominately employed when the need for a coronary artery bypass graft (CABG) is imminent. Discontinuing Brilinta normally requires three days before such a surgery can occur. This shortens the time period for the reversal thereby shortening the time to the CABG.
- There are certainly many more changes in both ICD-10-CM and ICD-10-PCS. Please take the time to attend a webinar, review your code books, and read other publications to make sure that you are ready for October 1st code changes.
Keep an eye out for the next Harmony Healthcare webinar coming in December covering the 2026 CPT code updates. Until then, happy coding.
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This article was authored by Dianna Foley, RHIA, CCS, CDIP, CHPS, External Education Partner/Consultant
