News: CMS releases FY 2027 ICD-10-CM coding guidelines

CMS has published the fiscal year (FY) 2027 ICD-10-CM Official Guidelines for Coding and Reporting. This accompanies the ICM-10-CM update, which is effective October 1, 2026. Clarifications and revisions have been added to several areas of the guidelines, including sepsis, cancer treatment, hypertension, genetic disorders, and Z codes.

In terms of guideline titles, one change reduces the wording of Guideline I.C.1.d., which addresses sepsis, severe sepsis, and septic shock. The previous title specified “infections resistant to antibiotics,” but that phrase has been removed, broadening the guideline’s language to apply to cases of sepsis, severe sepsis, and septic shock more generally.

Another clarification appears in Guideline I.C.2.e., regarding admissions and encounters for cancer treatment. The guideline now specifically refers to chemotherapy, immunotherapy, and radiation therapy that are antineoplastic, rather than using the broader terms chemotherapy, immunotherapy, and radiation therapy. This clarifies that the guidance applies to therapies used for treating neoplasms.

The guidelines also made minor revisions related to hypertension. The guidance for hypertensive heart disease now uses the phrase “hypertension with one or more heart conditions.” This wording clarifies that the category I11 (hypertensive heart disease) applies when hypertension is documented with one or more of the specified heart conditions, rather than implying that only a single qualifying heart condition can be present. This update continues to direct coders to assign additional codes when required to identify the qualifying heart conditions.

In addition, the guidelines expand guidance for hypertensive crisis by specifically including I1A.- (other hypertension) as a possible hypertensive disease code. When a patient has a documented hypertensive urgency, hypertensive emergency, or unspecified hypertensive crisis, a code from category I16.- (hypertensive crisis) is assigned. The identified hypertensive disease is also coded, which may include codes from categories I10-I15 or I1A.-. This addition provides clearer direction for cases in which another form hypertension is documented along with the hypertensive crisis.

Beyond guideline titles, a notable revision within this guidance is the expansion of chapter 17 to include genetic disorders. The chapter title now reads “Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders (Q00-QA1).” The update directs coders to assign appropriate codes from Q00-QA1 when a malformation, deformation, chromosomal abnormality, or genetic disorder is documented. The guidelines also clarify that these codes may be used throughout a patient’s lifetime, even when the condition is not identified until later in life.

The addition of category QA1.- as part of the range of codes is particularly significant, since it now provides coding options of genetic disorders associated with neoplasms that are not classified elsewhere.

Lastly, the guidelines add clarifications involving exposure to diethylstilbestrol (DES). Code Z84.A (family history of exposure to diethylstilbestrol) is now included among the list of history Z code categories. It is used when a family member was exposed to DES and that exposure could place the patient at increased risk for an associated condition.

Another related clarification was added to code Z91.B (personal risk factor of exposure to diethylstilbestrol) and is listed under the miscellaneous Z codes/subcategories/categories. This code identifies patients who were directly exposed to DES in utero, such as when the patient’s mother was exposed during the pregnancy.

Editor’s note: To read the full updated guidance, click here. To read additional coverage from JustCoding, click here.