Introduction on FY 2026 ICD-10-PCS Updates
This document details recent modifications to the procedural codes, primarily affecting the cardiovascular system, musculoskeletal system (specifically joints and bones), and nervous system. These changes are incorporated within both the Medical and Surgical and the New Technology and Extracorporeal or Systemic Assistance and Performance sections. The revisions to these tables necessitate adjustments in the coding for a variety of existing procedures and enable more precise coding for future interventions.
Cardiovascular system -FY 2026 ICD-10-PCS Updates
Filtration procedures
Three new codes have been introduced pertaining to filtration devices and associated procedures. Two of these devices are designed for the capture and removal of embolic debris within blood vessels, which may occur during a procedure, while the third device facilitates the removal of specific medications from the bloodstream.
Specifically, within Table 5A0 (Extracorporeal or systemic assistance and performance, Physiological systems, Assistance), a new function value, Cerebral embolic filtration (6), has been added. The corresponding qualifier values denote either an Extracorporeal flow reversal circuit (Q) or the specific type of filter employed: Single capture (M), Dual capture (N), or Single deflection (P).
Furthermore, in Table X2A (New technology, Cardiovascular system, Assistance), the new device/substance/technology value Cerebral embolic filtration, single integrated distal filter (4) has been established. This code is applicable during stent deployment or following carotid artery dilation. It is important to note that separate reporting of a code from Table 037 (Medical and surgical, Upper arteries, Dilation) is required for the carotid artery dilation and stent placement aspects of the procedure.
Finally, Table XXA (New technology, Physiological systems, Assistance) now includes the new device/substance/technology value Filtration, ticagrelor (9). This procedure involves the extracorporeal apheresis of the antiplatelet drug ticagrelor to mitigate the risk of bleeding, particularly prior to surgical interventions.
Arteries and veins – FY 2026 ICD-10-PCS Updates
In Table 031 (Medical and surgical, Upper arteries, Bypass), a new qualifier value, Upper artery (Y), has been added. This bypass procedure extends from the innominate artery to either a subclavian or axillary artery and is employed in the context of a thoracic endovascular aortic repair (TEVAR) for aortic arch aneurysms or dissections.
Additionally, Table X27 (New technology, Cardiovascular system, Dilation) features a new device/substance/technology value for Intraluminal device, cell impermeable (5). This device is utilized for the dilation of an arteriovenous fistula and incorporates a middle layer that prevents device migration. The device addresses lesions remaining after percutaneous transluminal angioplasty (PTA), requiring a separate code to be reported for the PTA component of the procedure.
Heart and aorta -FY 2026 ICD-10-PCS Updates
In both Table 02U (Medical and surgical, Heart and great vessels, Supplement) and Table 04U (Medical and surgical, Lower arteries, Supplement), the new device value Intraluminal device, endovascular anchors (L) has been added. This device facilitates the repair of aortic aneurysms by enhancing graft securement.
Within Table X28 (New technology, Cardiovascular system, Division), a new device/substance/technology value, Leaflet laceration, radiofrequency energy (W), has been introduced. This procedure involves the modification or splitting of heart valve leaflets to prevent or manage complications. These leaflets, also known as cusps, are critical in regulating blood flow through the cardiac chambers.
Table X2H (New technology, Cardiovascular system, Insertion) now includes a new qualifier value, Temporary phrenic nerve/diaphragm stimulation electrodes (X). These electrodes are inserted via the superior vena cava and stimulate the phrenic nerves and diaphragm to improve respiratory function in patients experiencing breathing difficulties.
Furthermore, Table X2V (New technology, Cardiovascular system, Restriction) incorporates a new device/substance/technology value, Intraluminal device, uncovered with support cuff (6). This code reports the restriction of the thoracic aorta utilizing a hybrid intraluminal device. The integrated cuff is designed to securely anchor the stent to the surgical graft. It is mandatory to report ascending aorta or hemiarch repair separately using a code from Table 02R (Medical and surgical, Heart and great vessels, Replacement).
Cardiac resynchronization therapy -FY 2026 ICD-10-PCS Updates
A series of new codes have been added to facilitate the reporting of cardiac resynchronization therapy (CRT). CRT addresses heart failure by employing a specialized pacemaker designed to synchronize ventricular contractions. This pacemaker is powered by a subcutaneously implanted battery. The procedure necessitates the reporting of two distinct codes:
- In Table X2H (New technology, Cardiovascular system, Insertion), the new device/substance/technology value Conduit to short-term external heart assist system (F) has been added. This code reports the pacemaker component of the procedure.
- In Table XHH (Medical and surgical, Skin, subcutaneous tissue, fascia, and breast, Insertion), the new device/substance/technology value Ultrasound transmitter and battery for endocardiac pacing electrode (H) has been added. This code reports the battery component of the procedure.
Joints and bones- FY 2026 ICD-10-PCS Updates
Table 0RR (Medical and surgical, Upper joints, Replacement) now includes the new qualifier value Subscapularis-sparing technique (8). This qualifier is utilized in conjunction with shoulder joint body part values (J, K) when performing a rotator cuff repair involving the replacement of the humeral head with a metal implant and the glenoid surface with a shallow plastic implant.
In Table 0SR (Medical and surgical, Lower joints, Replacement), new qualifier values for Medial and Lateral meniscus (D, E) have been added. These additions allow for specific coding of the appropriate meniscus during knee replacement procedures.
The device value Internal fixation device, bone-density-specific thread and porosity pattern (H) has been incorporated into three distinct tables. This device, a 3D-printed titanium implant customized to the patient’s specific bone density, is employed for sacroiliac joint fusion and pelvic fracture fixation. The affected tables are:
- Table XNH (New technology, Bones, Insertion) for pelvic bone body part values (6, 7).
- Table XNS (New technology, Bones, Reposition) for femoral shaft body part values (E, F) and pelvic bone body part values (N, P).
- Table XRG (New technology, Joints, Fusion) for sacroiliac joint body part values (E, F).
Table XRG (New technology, Joints, Fusion) also features a new device/substance/technology value, Interbody fusion device, custom-made anatomically designed (R). This adjustable device is utilized in cervical, cervicothoracic, thoracolumbar, lumbar, and lumbosacral joints for the correction of spinal deformities in adult patients, with the capability to be tailored to individual patient requirements.
Table XRH (New technology, Joints, Insertion) includes the new device/substance/technology value Molybdenum rhenium alloy spinal stabilization device (G). This device, a component of fusion procedures, offers enhanced strength, durability, and biocompatibility compared to alternative devices. Vertebral infusion should be reported separately using Table 0RG (Medical and surgical, Fusion, Upper joints).
Within Table XW0 (New technology, Anatomical regions, Introduction), the new device/substance/technology value Peptide enhanced bone void filler (X) has been added. This substance is utilized in transforaminal lumbar interbody fusion procedures for degenerative disc disease. Coders are required to report the fusion procedure separately using a code from Table OSG (Medical and surgical, Fusion, Lower joints).
Nervous system
In Table X05 (New technology, Nervous system, Destruction), the new device/substance/technology value Focused ultrasound therapy (4) has been added. This represents an investigational focused ultrasound brain tumor ablation procedure employing therapies such as sonodynamic therapy for tumor destruction. Sonodynamic therapy treats cancer using low-intensity ultrasound in conjunction with a chemical agent. Separate reporting of the administration of any blood-brain barrier disruption substances or therapeutics, if applicable, is required using Table 3E0 (Administration, Physiological systems and anatomical regions, Introduction).
Also in Table X05, the new device/substance/technology value Radiofrequency ablation (3) has been added. This procedure utilizes radiofrequency energy to ablate nerves for the relief of chronic pain or the treatment of certain tumors.
Ear, nose, sinus
A new table, 09X (Medical and surgical, Ear, nose, sinus, Transfer), has been established to report the transfer of vascularized nasal tissue for the repair of skull base defects. This procedure involves the use of a mucosa-based flap originating within the nasal cavity. The qualifier values delineate the specific skull bones: Frontal (1), Ethmoid (2), Sphenoid (3), and Occipital (4).
Mouth and throat- FY 2026 ICD-10-PCS Updates
A new table, 0C1 (Medical and surgical, Mouth and throat, Bypass), has been created to report cricothyroidotomy. This is an emergency procedure to establish an airway through an incision in the cricothyroid membrane of the neck. The body part is larynx (S), and the device is Intraluminal, endotracheal airway (E). This new table facilitates the distinction between cricothyroidotomy, which involves the cricothyroid membrane in the neck, and tracheostomy, which involves the trachea.
Hepatobiliary system and pancreas
In Table 0F1 (Medical and surgical, Hepatobiliary system and pancreas, Bypass), the body part value Common bile duct (9) has been relocated to a dedicated row with the approach Percutaneous endoscopic (4). This revision enables the specific coding of endoscopic choledochoduodenostomy, a procedure that establishes a connection between the common bile duct and the duodenum to facilitate biliary drainage.
Other tables – FY 2026 ICD-10-PCS Updates
In Table 8E0 (Other procedures, Physiological systems and anatomical regions, Other procedures), a new method value, Confocal microscopy (G), and a qualifier value, Intraoperative specimen analysis (P), have been added. This allows for the intraoperative imaging of the internal microstructure of tissues utilizing fluorescence and non-ionizing, low-power optical radiation.
A new table, XDJ (New technology, Gastrointestinal system, Inspection), has been added, incorporating the device/substance/technology value Ingestible capsule with light absorption sensor (L). This device is orally administered, and subsequent spectrophotometry (light absorption technology) is employed to detect the presence or absence of blood within the gastrointestinal tract.
New technology substances- FY 2026 ICD-10-PCS Updates
New rows have been incorporated into Table XW0 (New technology, Anatomical regions, Introduction) for the following new device/substance/technology values:
Antibiotics
- Aztreonam-avibactam anti-infective (P): Utilized for the treatment of multidrug-resistant bacteria.
- Fosfomycin anti-infective (W): Indicated for the treatment of complicated urinary tract infections, complicated intra-abdominal infections, hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia, and acute bacterial skin and skin structure infections.
Monoclonal antibodies
- Letetresgene autoceucel (R): A T-cell therapy employed for the treatment of adult patients with unresectable or metastatic synovial sarcoma.
- Rozanolixizumab-noli monoclonal antibody (T): Utilized for the treatment of generalized myasthenia gravis in adult patients.
Other drugs
- Iloprost (Q): Indicated for the treatment of severe frostbite in adult patients.
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