ICD-10-CM Updates and Proposed Physician Fee Schedule for 2026-Webinar Recording

Video Transcription

Video Summary

Lynn Andren reviews major ICD-10-CM updates effective October 1, 2025, and discusses the 2026 Physician Fee Schedule Proposed Rule, due for finalization in November 2025. The ICD-10-CM updates include 487 new codes, 38 revisions, and 28 deletions. Key areas affected are Chapter 19 (injury), Chapter 12 (skin diseases), infectious diseases, neoplasms, endocrine disorders, and others. Notable changes include specific infestation codes, new breast cancer neoplasm codes by laterality, type 2 diabetes remission codes, multiple sclerosis phenotypes, detailed non-pressure ulcer codes with laterality and severity, and expanded social determinants of health codes for financial insecurity, war exposure, and food allergies. Emphasis is placed on accurate, specific documentation to support appropriate coding and reimbursement, avoiding denials due to nonspecific codes.<br /><br />The Physician Fee Schedule Proposed Rule suggests a conversion factor increase tempered by efficiency adjustments, shifting practice expense methodology toward hospital cost data, and potential telehealth expansions. Behavioral health and chronic care management enhancements are proposed, including mandatory heart failure and low back pain programs from 2027-2031. Drug pricing and anesthesia conversion factor proposals are being reviewed, with outcomes pending. Providers are urged to update practice management systems to handle old and new codes based on service dates properly. The final rule will clarify these changes for 2026 implementation.

Keywords

ICD-10-CM 2025 updates

code deletions and revisions

parent code specificity

practice management system update

EHR update

Hodgkin’s lymphoma remission code

diabetes type 1 coding

social determinants of health codes

ICD-10-CM updates 2025

Physician Fee Schedule 2026

new diagnosis codes

medical coding revisions

telehealth expansion

behavioral health programs

practice expense methodology

chronic care management