Welcome to your essential coding update newsletter for 2026!
Whether you’re a coder, clinician, biller, or practice manager, this year’s coding changes to ICD-10-CM/PCS and CPT are significant and will impact documentation, billing, compliance, and revenue integrity. Staying ahead of these changes will not only reduce denials and audit risk but also strengthen patient care documentation and operational efficiency.
In this edition, we’ll walk you through:
- What’s new in ICD-10-CM & PCS updates effective 2026
- Key changes to CPT codes for 2026
- Documentation and workflow tips to stay compliant
- Practical steps for implementation across your practice
Let’s dive in!
ICD-10 Coding Changes: What’s New in 2026?
The FY 2026 ICD-10-CM & PCS code set is now active for patient encounters and discharges on or after October 1, 2025, running through September 30, 2026.
This update reflects thousands of edits aimed at improving clinical specificity, clarifying diagnosis capture, and aligning the classification with modern medical practice. According to CMS and coding resources:
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- Over 600 new codes were added,
- Hundreds of codes were revised, and
- Several existing codes were deleted or restructured.
These changes significantly affect how we describe diagnoses and inpatient procedures — so let’s break down the essentials.
A Closer Look: New ICD-10-CM Codes
The 2026 ICD-10-CM update features a large set of new diagnosis codes — nearly 487 billable codes — that expand specificity for conditions clinicians encounter every day.
Key Areas of Expansion
Here are some clinical domains with notable changes:
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- Pain and Musculoskeletal Reporting
- The abdominal and pelvic pain section received expanded codes to differentiate laterality and additional location specifics like flank pain and pelvic-perineal pain.
- Oncology Updates
- New designations improve precision for inflammatory breast cancer and genetic susceptibility codes for malignancies involving fallopian tubes, urinary tract, digestive system, and colorectal cancer.
- Ophthalmologic Changes
- Eye and adnexa coding now includes more granular terms for eyelid inflammation by specific location and thyroid orbitopathy.
- Chronic Ulcer Detailing
- Non-pressure, chronic ulcers are now described with codes that specify location and severity — a big improvement for wound care documentation.
Taken together, these revisions enhance our ability to capture clinical nuance and support improved analytics, quality reporting, and patient outcomes.
ICD-10 Deletions & Revisions You Must Know
It’s not just about new codes — many older codes were revised or deleted to eliminate redundancy and outdated terminology. Practices need to:
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- Stop using deleted codes immediately,
- Understand how revised codes change clinical meaning, and
- Update clinical documentation templates to reflect the new structure.
These deletions and revisions are particularly important in chronic disease coding, symptom reporting, and injury/trauma categories where mis-coding can disrupt risk adjustment and quality measurement.
Quarterly & NCD ICD-10 Updates
In addition to the annual ICD-10 update (effective October 1), CMS issues quarterly ICD-10 coding revisions tied to National Coverage Determinations (NCDs). Two notable updates:
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- January 1, 2026 ICD-10 revisions impacting NCD codes — requiring practices to revise diagnosis code usage for certain covered services.
- April 1, 2026 quarterly update — another set of ICD-10 coding changes specific to national coverage and documentation rules.
This means ICD-10 updates aren’t “once a year” anymore — they’re rolling, and practices must monitor them throughout the year.
CPT Coding Changes: What’s New for 2026?
The AMA released the 2026 CPT code set, effective January 1, 2026, with substantial additions and revisions that reflect advancements in medical practice.
Highlights include:
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- 288 new codes
- Significant revisions to existing codes
- CPT deletions
- Updates to procedural definitions and reporting guidelines
These updates reinforce the use of CPT as the core language for reporting service and procedure data in outpatient, professional, and ancillary billing. They also pave the way for better tracking of clinical innovations — from digital health to AI-assisted services.
Top CPT Changes to Know in 2026
Here’s an overview of the biggest shifts in the CPT landscape this year:
1. Remote Patient Monitoring Evolves
Five new codes were added to capture short-duration remote monitoring services (2-15 days), responding to emerging tech and clinical evidence that shorter monitoring periods can deliver meaningful outcomes.
These codes expand access and reimbursement options for providers managing chronic conditions — especially when continuous monitoring isn’t necessary.
2. Behavioral Health & Telehealth Flexibility
CPT structure now includes more behavioral health services in appendices P and T, recognizing their validity when delivered via audio-video or audio-only telehealth modalities.
This is key for practices serving rural or underserved populations where access to in-person care is limited.
3. Diagnostic and Therapeutic Procedure Refinements
Several procedural areas saw updates:
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- Radiology & imaging procedures, including cerebral perfusion and CTA head/neck imaging transitions, experienced recoding and bundling-related guidance.
- Irreversible electroporation treatments now have organ-specific codes (e.g., liver, prostate).
- Hearing device and sleep apnea therapy codes were altered to align with updated clinical practices.
These refinements reflect both clinical sophistication and payer expectations — and they require coders to understand not just the code itself, but the clinical scenario it represents.
CPT Deletes, Revisions & Reporting Tips
To keep your practice out of trouble:
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- Retire deleted codes and adjust workflow instructions for all affected departments.
- Document procedure details carefully, especially for new service definitions (e.g., remote monitoring duration).
- Train clinicians on how procedural language differs from prior versions — it’s not just a code change; it’s a documentation change.
Also, many coders report that CPT changes include modality designations, bundling clarifications, and revised descriptors — all of which must be reflected in charge capture and EHR workflows.
Documentation Challenges & Best Practices
Coding changes don’t happen in isolation — they ripple out into documentation practices, EHR templates, billing processes, and operational policies. To minimize coding errors and reduce denials, consider the following strategic steps:
Educate Your Team Early
Don’t wait until claims start going out. Prepare training sessions or lunch-and-learns covering:
- ICD-10 new vs. deleted codes
- CPT new codes and reporting rules
- Specialty-specific changes (e.g., cardiology, orthopedics, radiology)
Early education prevents the “guessing game” that often results in undercoding, upcoding, or denial.
Update EHR & Practice Management Tools
Include:
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- Latest ICD-10 and CPT code sets
- Clinical decision support prompts tied to updated guidance
- Smart defaults and documentation prompts that match new definitions
Make sure your EHR vendor or internal IT team applies updates promptly — outdated code sets are a leading cause of coding errors.
Tie Clinical Documentation to Coding Needs
A digitized, checkbox-only approach won’t work here. New codes often require specific clinical details — laterality, severity, monitoring duration, equipment specifics, and genetic risk qualifiers.
Ask providers:
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- “Where does the pain occur, exactly?”
- “How long did the monitoring last?”
- “What device or approach was used?”
These questions matter now more than ever.
Audit Early and Often
Internal audits help ensure:
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- Correct code selection
- Documentation supports the code
- Claims pass payer edits
Begin audits as soon as changes go live — early mistakes are costly and many don’t show up until weeks later when a pattern of denials builds.
Partner With Payers and Billers
Payer edits often lag behind official updates — so confirming payer acceptance of codes early is a smart move. Clarify:
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- Whether remote monitoring codes are reimbursed
- How payers treat telehealth vs. in-person codes
- Any additional documentation they require for new codes
Your billing team should also align modifiers and reporting strategies to each payers’ nuances.
What This Means for You: Bottom-Line Impacts
Let’s translate these coding changes into real world implications:
Revenue Cycle Impact
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- Improved specificity = fewer denials
- But new codes may trigger payer audit flags if documentation is insufficient
- Training and accurate mapping reduce write-offs and resubmissions
Clinical Quality Impact
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- Enhanced clinical detail drives better quality reporting
- More specific codes help with outcomes tracking and risk adjustment
Compliance & Audit Readiness
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- Outdated codes are a major audit risk
- Updated guidelines reduce exposure to recoupments
Wrap-Up & Action Checklist
Here’s a quick implementation checklist to keep you on track:
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- Download and incorporate 2026 ICD-10 and CPT code sets
- Educate clinicians and coders before January 1, 2026
- Update EHR templates and billing systems
- Run internal audits monthly through Q2 2026
- Confirm payer acceptance of new procedural codes
- Document new and revised clinical terms comprehensively
Coding changes are more than a yearly event — they are a strategic layer of your practice’s success. This year’s updates include expanded diagnosis detail in ICD-10 and transformative procedural language in CPT that mirror the rapid advancement of clinical care.
Staying current not only helps you get paid — it strengthens the accuracy of patient records, enhances quality reporting, and ensures your operational resilience in a complex healthcare environment.
If you ever feel overwhelmed — remember: consistent education, smart process updates, and open communication between providers, coders, and billers are your best defense.