2026 ICD-10-CM Updates: Key Additions, Deletions & Risk Adjustment Impacts
ICD-10-CM 2026 Updates Are Here—and They Matter More Than Ever for Risk Adjustment CMS is rolling out major changes effective October 1, 2025, including new codes for Type 2 diabetes in remission and inflammatory breast cancer, plus the deletion of 28 codes—3 of which currently map to HCCs. In my latest article, I break down: • What’s changing and why it matters • How new codes like E11.A and C50.A0–A2 impact RAF scores and audit risk • What coders, providers, and risk adjustment teams must do now to stay compliant and protect revenue Whether you're leading a coding team, managing risk adjustment strategy, or educating providers—this is must-read.
ProTrust Billing Partners LLC
10/12/20251 min read
My post contentThe FY2026 ICD-10-CM update, effective October 1, 2025, introduces critical changes that directly affect HCC mapping, RAF scores, and audit exposure. Below are high-impact additions and important deletions that risk adjustment teams and providers need to act on now.
Deletions: 3 HCC-Mapped Codes Retired
Of the 28 ICD-10 codes slated for deletion, three—D71, E72.53, and G35—are currently mapped to the V28 HCC model. These codes will no longer be valid for payment after October 1, 2025. Each now requires additional characters to specify the type or manifestation of the condition.
Action: Ensure accurate code selection by updating templates and retraining teams to use the new, more specific codes.
Addition: Type 2 Diabetes Mellitus in Remission (E11.A)
This new code identifies patients with Type 2 diabetes in remission—a state of glycemic control without active treatment, but not a cure.
Key Points:
• Use only when documentation explicitly states “in remission”
• Not valid if the patient has active diabetic complications (e.g., neuropathy, retinopathy)
• Do not use for Type 1, autoimmune, secondary, or drug-induced diabetes—even if in remission
Risk Adjustment Impact:
• E11.A may not map to an HCC; misuse can lead to RAF score loss and payment reduction
• Audit risk increases if documentation doesn’t clearly support remission status
Addition: Inflammatory Breast Cancer (C50.A0–C50.A2)
New codes now distinguish inflammatory breast cancer (IBC)—a rare, aggressive subtype—from general breast cancer diagnoses.
New Codes:
C50A0 Malignant inflammatory neoplasm of unspecified breast
C50A1 Malignant inflammatory neoplasm of right breast
C50A2 Malignant inflammatory neoplasm of left breast
Why it matters:
· Provides clinical specificity for IBC, often misclassified as mastitis
· Supports treatment justification and strengthens audit defense
Final Thoughts
These updates reinforce CMS’s push for greater diagnostic precision. As we prepare for FY2026, now is the time to:
· Update coding tools and workflows
· Educate providers on documentation requirements
· Audit high-risk areas to prevent revenue loss and compliance issues