Key takeaways
- 1,176 new ICD-10-CM codes take effect October 1, 2025
- Cardiology, orthopedics, and behavioral health see the largest changes
- Begin preparation at least 90 days before the effective date
- SDOH documentation is becoming increasingly important for value-based care
- Failure to update code sets results in automatic claim denials
The Centers for Medicare & Medicaid Services (CMS) has released its annual update to the ICD-10-CM code set, effective October 1, 2025 for fiscal year 2026. This year's update includes over 1,176 new codes, 28 revised codes, and 58 deleted codes. These changes span virtually every specialty and will have significant implications for coding accuracy, claim reimbursement, and compliance. Below we break down the most impactful changes and provide actionable steps to get your practice ready before the deadline.
Major Changes by Specialty
Cardiology sees the largest single-specialty impact with 89 new codes, primarily around congenital heart defects, electrophysiology procedures, and heart failure classifications. The new codes provide greater specificity for left ventricular assist device (LVAD) complications and post-procedural cardiac conditions.
Orthopedics receives 67 new codes covering fracture healing complications, prosthetic joint infections, and spinal stenosis subtypes. Laterality requirements have been expanded for several existing fracture codes.
Mental health and behavioral health see 54 new codes, including expanded social determinants of health (SDOH) codes that allow providers to document food insecurity, housing instability, and transportation barriers with greater precision.
Practical tips
- Start training your coding team on new codes at least 60 days before the October 1 effective date
- Run a gap analysis on your most frequently used codes to identify any that are being deleted or revised
- Update your EHR templates to incorporate new code options and prompts
Deleted and Revised Codes: What to Watch For
When a code is deleted, CMS maps it to one or more replacement codes. However, these mappings are not always one-to-one. A single deleted code might map to three or four new codes, each requiring additional clinical documentation to select the correct replacement.
The 28 revised codes this year primarily involve descriptor changes that clarify clinical intent. While these may seem minor, they affect code selection algorithms in your EHR and coding software. Manual review of revised code descriptions is required.
Practices that do not update their code sets by the effective date risk submitting claims with invalid codes, leading to automatic denials that are entirely preventable.
Watch out for
- Claims submitted with deleted codes after October 1 will be automatically denied by all payers
- Some EHR vendors delay their code updates — confirm your vendor's update timeline now
- Superbills and encounter forms must be updated to reflect new and revised codes
Preparing Your Practice: A 90-Day Action Plan
Day 1–30: Conduct a code audit. Identify your top 100 most-used ICD-10 codes and cross-reference them against the 2026 update. Flag any codes that are deleted, revised, or supplemented by new alternatives.
Day 31–60: Update all coding resources, including superbills, encounter forms, EHR templates, and coding reference materials. Schedule training sessions for all coders, billers, and clinical staff who participate in documentation.
Day 61–90: Run a parallel coding exercise where staff code encounters using both the current and new code sets. This identifies gaps in understanding and allows for real-time correction before the go-live date.
Practical tips
- Designate a 'code champion' in each department to lead the transition
- Create a quick-reference guide for the most impactful changes specific to your specialty
- Set up weekly coding accuracy audits for the first 90 days post-implementation
About this article
Published by the DrCareMSO team. It is general information for practice owners and billing staff, not legal, coding or compliance advice. Coding rules and payer policies change, so check current CMS, AMA and payer guidance before you act.
Social Determinants of Health (SDOH) Expansion
CMS continues to expand the Z-code category for social determinants of health. The 2026 update adds 23 new SDOH codes covering digital literacy barriers, childcare access issues, immigration-related stress, and climate-related health impacts.
While SDOH codes are supplementary and do not directly drive reimbursement, they are increasingly used by payers for risk adjustment, quality measure reporting, and population health analytics. Practices that document SDOH consistently may see benefits in value-based care contracts.
Several major payers, including UnitedHealthcare and Anthem, have announced incentive programs for practices that demonstrate systematic SDOH documentation starting in 2026.