CMS Proposes Significant ICD-10-CM Code Updates in the FY 2026 IPPS Proposed Rule
On April 11, 2024, the Centers for Medicare & Medicaid Services (CMS) released the Fiscal Year (FY) 2026 Hospital Inpatient Prospective Payment System (IPPS) proposed rule, which includes substantial revisions to the ICD-10-CM code set. The proposal outlines the following changes:
487 new ICD-10-CM codes
38 revised code descriptions
28 codes proposed for invalidation
Key Additions by ICD-10-CM Chapter
Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00–T88)
This chapter features the most significant number of additions, with 213 proposed new codes. These revisions aim to enhance specificity by incorporating laterality and depth for various injuries, such as:
Contusions
Abrasions
Nonthermal blisters
External constrictions
Nonvenomous insect bites
Lacerations
Puncture wounds
Open bites
Additional proposed codes in Chapter 19 address:
Poisoning due to fluoroquinolone antibiotics and xylazine
Anaphylactic reactions and other adverse food responses
New entries for Gulf War syndrome and conditions resulting from service in other war theaters
Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00–L99)
A significant number of new codes are proposed for non-pressure chronic ulcers, which will specify:
Anatomic location
Ulcer stage
Presence of tissue involvement (e.g., skin breakdown, fat exposure, muscle necrosis, or bone involvement)
Examples include:
L98.431 – Non-pressure chronic ulcer of abdomen, limited to skin breakdown
L98.452 – Non-pressure chronic ulcer of neck with fat layer exposed
L98.473 – Non-pressure chronic ulcer of groin with muscle necrosis
L98.A216 – Non-pressure chronic ulcer of right forearm with bone involvement, no necrosis
Other Notable Proposed Changes
Chapter 2: Neoplasms (C00–D49)
Introduction of three new codes to classify malignant inflammatory neoplasms of the breast, enhancing clinical identification and reporting.
Chapter 6: Diseases of the Nervous System (G00–G99)
Eight new codes to better specify types of multiple sclerosis (MS), including:
Relapsing-remitting MS
Active and non-active primary/secondary progressive MS
Chapter 7: Diseases of the Eye and Adnexa (H00–H59)
Expanded detail under code H01.8 for inflammations of the eyelid, divided into nine laterality-specific codes
Four new codes to describe thyroid eye disease (TED), also termed thyroid orbitopathy
Chapter 18: Symptoms, Signs, and Abnormal Clinical and Laboratory Findings (R00–R99)
Addition of 18 codes to capture pain and tenderness with greater anatomical specificity, including:
Pelvic and perineal pain
Multi-site abdominal pain
Flank and costovertebral angle tenderness
Chapter 21: Factors Influencing Health Status and Contact with Health Services (Z00–Z99)
Expansion of social determinants of health codes, with three new codes under Z59.86, targeting varying levels of financial insecurity
Proposed Code Invalidations
Many of the 28 codes marked for deletion are being restructured as subcategories to accommodate more granular options. This includes updates for:
Multiple sclerosis (G35)
Eyelid inflammation (H01.8)
Pelvic/perineal pain (R10.2)
Financial insecurity (Z59.86)
ICD-10-PCS Updates
The proposed ICD-10-PCS updates are more limited, featuring only 14 new procedure codes:
8 codes for wound management in the integumentary and musculoskeletal systems
Additional codes address:
Cardiovascular supplementation procedures
Lower arterial interventions
Extracorporeal/systemic therapies (e.g., hypothermia treatment)
New technology applications