News: More than 480 new ICD-10-CM, 10 ICD-10-PCS codes in 2026 IPPS proposed rule

CMS recently proposed hundreds of ICD-10-CM code changes in the 2026 Hospital Inpatient Prospective Payment System (IPPS) proposed rule, published April 11, including:

• 487 new codes
• 38 revised codes (for descriptions)
• 28 invalidated codes

Chapter 19: Injury, Poisoning, and Certain Other Consequences of External Causes (S00-T88) holds the most additions with 213 proposed codes. The majority of these codes would allow injury coding by laterality and depth, with conditions including contusions, abrasions, nonthermal blisters, external constrictions, nonvenomous insect bites, lacerations, puncture wounds, and open bites. The remaining codes are primarily related to poisonings of fluoroquinolone antibiotics and xylazine, anaphylactic reactions, and other adverse food reactions.

This chapter could also introduce codes for Gulf War syndrome, “a cluster of medically unexplained chronic symptoms that can include fatigue, headaches, joint pain, indigestion, insomnia, dizziness, respiratory disorders, and memory problems,” as described by the Department of Veterans Affairs, as well as codes for the effects of other theaters of war.

The second largest majority of codes fall under Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99) to capture non-pressure chronic ulcers. Most of these codes specify both the location of the ulcer as well as the staging and appearance. Potential codes include:

• L98.431, Non-pressure chronic ulcer of abdomen limited to breakdown of skin
• L98.452, Non-pressure chronic ulcer of neck with fat layer exposed
• L98.473, Non-pressure chronic ulcer of groin with necrosis of muscle
• L98.A216, Non-pressure chronic ulcer of right forearm with bone involvement without evidence of necrosis

Other notable additions impact the following chapters:

• Chapter 2: Neoplasms (C00-D49)
  • Three new codes to capture malignant inflammatory neoplasms of breasts, allowing physicians to more readily identify patients with this form of breast cancer
• Chapter 6: Diseases of the Nervous System (G00-G99)
  • Eight new codes to further specify multiple sclerosis (MS), such as relapsing-remitting MS, active primary or secondary progressive MS, and non-active primary or secondary MS
• Chapter 7: Diseases of the Eye and Adnexa (H00-H59)
  • An expansion of current eyelid-inflammation code H01.8 (other specified inflammations of eyelid) into nine laterality codes based on whether the upper, lower, or both eyelids are affected
  • Four new codes for thyroid eye disease (TED), a condition common among patients with thyroid disease, that would be listed as thyroid orbitopathy
• Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)
  • Eighteen new codes to specify pain and tenderness at a higher level, particularly for pelvic and perineal pain, abdominal pain of multiple sites, flank pain and tenderness, and costovertebral (angle) tenderness
• Chapter 21: Factors Influencing Health Status and Contact With Health Services (Z00-Z99)
  • Three new codes that expand on current social determinants of health code Z59.86 for financial insecurity

Many of the proposed code invalidations consist of removing codes and turning them into subcategories to make room for more specified code additions, such as those for MS (G35), other specified inflammations of eyelid (H01.8), pelvic and perineal pain (R10.2), and financial insecurity (Z59.86).

On the other hand, ICD-10-PCS may see very few additions. Out of the proposed 14 new codes, eight of them are for wound management treatment of integumentary and musculoskeletal systems, with the remaining six spread between supplement of the heart and great vessels, supplement of lower arteries, Extracorporeal or systemic therapies for hypothermia, and new technologies.

The entire list of proposed 2026 ICD-10-CM and ICD-10-PCS code updates can be viewed in Tables 6A–6J.2 of the rule. CMS encourages community members to comment on these proposed changes until June 10 at 5 p.m. Eastern. Accepted changes will then be included in the 2026 code set and implemented October 1.

Editor’s note: This article originally appeared in JustCoding here. To read CMS’s 2026 IPPS proposed rule, click here.