Every spring CMS drops a new batch of proposed ICD‑10‑CM/PCS changes inside the IPPS rule. The FY 2026 packet (released April 11, 2025) is a whopper:
- 487 brand‑new diagnosis codes
- 38 revised descriptions
- 28 deletions/invalidations
- 14 new ICD‑10‑PCS procedure codes (yes, that’s all)
Clinicians, coders, and revenue‑cycle pros have until June 10, 2025 to weigh in before CMS locks everything for the October go‑live.
Diagnosis Codes You’ll Actually Use
| Hot Topic | Why It Matters | Proposed Code(s) |
|---|---|---|
| Type 2 Diabetes in Remission | Finally gives providers a way to show “yes, the A1c is normal without meds.” Think risk‑adjustment, quality metrics, and pay‑for‑outcomes programs. | E11.A Type 2 DM in remission |
| Non‑pressure Chronic Ulcers | 100+ additions spell out body‑part, laterality, and depth—great for wound‑care capture and HCC precision. | L98.431, L98.452, L98.473, L98.A2xx series, etc. |
| Injury Chapter Overhaul | 200+ codes add laterality & depth for contusions, bites, lacerations, punctures—you name it. Better detail = cleaner trauma registries. | S00–T88 expansions |
| Multiple Sclerosis Granularity | Eight new codes split relapsing‑remitting, active vs. non‑active progressive forms—expect neuro clinics to celebrate. | New G35.x sub‑categories |
| Thyroid Eye Disease & Eyelid Inflammation | More precise H01.8x & H05.2x options; helps ophthalmology nail medical‑necessity for biologics. | Nine eyelid-inflammation codes + 4 TED(Thyroid Eye Disease) codes |
| Social Drivers of Health | Gravity Project wins again: a code for digital literacy (Z55.7) and fresh housing‑instability details (Z59.818/819). | Z55.7, Z59.818, Z59.819 |
Procedure‑Code Snapshot (ICD‑10‑PCS)
PCS stayed quiet: only 14 new codes. Eight revolve around advanced wound‑management devices for integumentary & musculoskeletal systems; the rest cover vascular supplements, systemic hypothermia therapy, and “new tech” add‑ons. Translation: inpatient coders will see minimal impact, but make sure your chargemaster team flags those wound‑care kits.
Why This Drop Matters to Your Bottom Line
- Risk‑adjustment & Quality – New remission and SDOH codes can move RAF/HCC scores and social‑risk adjustment factors.
- Denials Prevention – Payers love “more specific code needed” excuses. Get ahead of it with updated reference‑sheets for providers.
- Education Touchpoints – Perfect fodder for lunch‑and‑learns or newsletter blurbs—especially wound‑care nurses, podiatrists, endocrinologists, and neurology teams.
- System Builds – EHR vendors will push test patches mid‑summer. Start the interface validation calendar now so October 1 doesn’t bite you.
Key Dates
| Milestone | What Happens |
|---|---|
| Now – June 10, 2025 | Comment period open—submit feedback via the CMS IPPS docket |
| Mid‑August 2025 | Final rule & finalized code set released |
| October 1, 2025 | Codes go live (FY 2026) in every U.S. transaction |
Action Plan for Busy Coding Teams
- Skim the Tables – Pull Tables 6A‑6J from the IPPS rule and highlight codes touching your specialties.
- Provider Checklist – One‑pager per service line focusing on what changed and documentation tips.
- Update Audit Templates – Add new detail fields (e.g., ulcer depth, MS activity) so reviews aren’t “unscorable” come fall.
- Track Payer Bulletins – Insurers may issue policy tweaks by September—set Google alerts or let your BI dashboard flag them.
- Speak Up – If a proposed code looks off (or amazingly helpful), submit a quick comment. CMS does adjust based on feedback.
This is one of the largest ICD‑10‑CM expansions in years, aimed squarely at clinical precision (and yes, better data for quality‑based payments). Lock your education calendar now so your teams—and your EHR—are ready when October 1 rolls around. If you need a hand building those provider tip sheets or running payer‑impact scenarios, you know where to find us.