ICD-10-CM Coding and Guideline Updates for FY2026

Overview

The ICD-10-CM Coding Guidelines and codes are updated every year on October 1^st. This webinar will provide information regarding the updates to the ICD-10-CM coding guidelines that become effective 10/1/2025 and information about new codes that will become effective 10/1/2025. The presentation will also provide a copy of the conversion table which shows which present ICD-10-CM codes will become invalid on 10/1/2025 and the more specific codes that will replace those newly invalid codes. The presenter will guide the participants through the processes they should follow to identify resident medical records that include codes that will become invalid and how the facility should review records to determine whether each resident’s medical record already contains enough information to allow the updated code to be appended. If the medical record does not contain enough information to allow the new code to be appended, a physician query must be initiated to request more specific documentation for that diagnosis.

The PDPM mapping file also includes new codes, removes invalid codes and changes how some diagnosis codes will map to payment beginning 10/1/2025. This information will be important for the SNF Medicare A teams to understand so they will know whether the chosen primary diagnoses will map to Medicare Payment. Some diagnosis codes that map to payment in September will not map to payment in October.

This presentation will also focus on how the nursing home team can keep their residents’ ICD-10-CM codes up to date. Resident face sheets and diagnosis lists must be accurate and report active diagnoses.