The Center for Medicare and Medicaid Services has released the FY 2027 updates to the ICD-10-CM code classification. There are less than half as many new codes this year as compared to last year, with the number of codes being added to a single chapter ranging from 1 to 60.
| Year | New Codes | Deleted Codes | Revised Code Titles |
| 2027 | 190 | 30 | 4 |
| 2026 | 487 | 28 | 38 |
This this table show the breakdown of code updates by chapter of ICD-10-CM.
| ICD-10-CM Chapter | New | Revised | Invalid |
| Chapter 1: Certain Parasitic and Infectious Diseases | 0 | 0 | 0 |
| Chapter 2: Neoplasms | 3 | 0 | 1 |
| Chapter 3: Diseases of the Blood and Blood Forming Organs | 2 | 0 | 0 |
| Chapter 4: Endocrine, Nutritional and Metabolic Diseases | 1 | 0 | 0 |
| Chapter 5: Mental, Behavioral and Neurodevelopmental Disorders | 0 | 0 | 0 |
| Chapter 6: Diseases of the Nervous System | 0 | 0 | 0 |
| Chapter 7: Diseases of the Eye and Adnexa | 0 | 0 | 0 |
| Chapter 8: Diseases of the Ear and Mastoid Process | 0 | 0 | 0 |
| Chapter 9: Diseases of Circulatory System | 9 | 0 | 3 |
| Chapter 10: Diseases of the Respiratory System | 6 | 0 | 0 |
| Chapter 11: Diseases of the Digestive System | 6 | 0 | 0 |
| Chapter 12: Diseases of the Skin and Subcutaneous Tissue | 1 | 3 | 0 |
| Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue | 31 | 0 | 9 |
| Chapter 14: Diseases of the Genitourinary System | 2 | 0 | 0 |
| Chapter 15: Pregnancy, Childbirth and the Puerperium | 44 | 0 | 0 |
| Chapter 16: Certain Conditions Originating in the Perinatal Period | 0 | 0 | 0 |
| Chapter 17: Congenital Malformations, Deformations and Chromosomal Abnormalities | 6 | 0 | 0 |
| Chapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified | 1 | 0 | 0 |
| Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes | 60 | 0 | 15 |
| Chapter 20: External Causes of Morbidity | 0 | 0 | 0 |
| Chapter 21: Factors Influencing Health Status and Contact with Health Services | 16 | 1 | 1 |
| Chapter 22: Codes for Special Purposes | 0 | 0 | 0 |
| Total | 190 | 4 | 30 |
The updates to the ICD-10-CM Official Guidelines for Coding and Reporting are minimal for 2027. The updates include the addition of one new guideline as well as rewording of or additions to four existing guidelines.
This table summarizes the guidelines with updates. Each guideline should be reviewed with an eye towards any changes it brings to correct coding practices.
| 2027 ICD-10-CM Coding Guidelines Updates | |
|---|---|
| I.C.9.a.1 | Hypertension with Heart Disease |
| I.C.9.a.10 | Hypertensive Crisis |
| I.C.17 | Congenital malformations, deformations, chromosomal abnormalities, and genetic disorders (Q00-QA1) |
| I.C.21.c.4 | Family history of exposure to diethylstilbestrol (New) |
| I.C.21.c.13 | Personal risk factor of exposure to diethylstilbestrol |
The hypertension guidelines in Chapter 9 are getting some minor wording changes.
The phrase “one or more” had been added to guideline I.C.9.a.1 – Hypertension with Heart Disease to specify that a code from category I11 Hypertensive heart disease is assigned for a patient who has one or more of the heart conditions for heart failure or other heart diseases listed in the guideline.
Additionally, the guideline for hypertensive crisis, I.C.9.a.10, was updated to add code I1A Resistant hypertension to the list of codes included in the “Code also” instruction in the guideline.
The title of Chapter 17 of ICD-10-CM is being updated with the addition of “genetic disorders” to the list of conditions whose codes are included in this chapter. Several updates were made to the guidelines for this chapter to include reference to genetic disorders.
A new code, Z84.A Family history of exposure to diethylstilbestrol was added to the list of family history Z codes included in the guidelines for Chapter 21. A note is included under this code explaining the circumstances under which this code is to be reported.
A note was also added to the guidelines for code Z91.B Personal risk factor of exposure to diethylstilbestrol specifying that this code is assigned when a patient had direct exposure to diethylstilbestrol while in utero.
Most of the entries added to or deleted from the index are related to the addition of new codes or the addition of new inclusion terms being added under some codes. There are several instances though where the index has changed the code directed for use for a particular search of the index, which sometimes even reclassifies the diagnosis to a new chapter of ICD-10-CM, or added new search terms providing a way to locate a code but not due to the introduction of a new code.
Examples:
The diagnoses of De Morgan’s spots and cecal polyp have been reclassified in the Alphabetic Index to a whole different chapter of ICD-10-CM. For example, previously, a search of the terms Polyp, cecum led to a code for a benign neoplasm of cecum from Chapter 2, but the changes to the index for 2027 now direct the assignment of a code for polyp of the colon from Chapter 11 Diseases of the Digestive System.
New terms have been added leading to code R41.0, clarifying this as the default code for a diagnosis of acute confusion.
Subterms have been added to allow for reporting sinusitis of odontogenic origin.
The greatest number of updates to ICD-10-CM for 2027 were made within the Tabular List. Updates consist primarily of adding new codes or expanding existing codes to provider greater specificity, but there were also a notable number of updates to instructional notes, such as the addition of Excludes1 and Excludes2 notes, Code first, Code Also and Use Additional Code notes, and Excludes1 or Excludes2 notes being changed to the other type of Excludes note. When coders begin assigning codes on October 1, 2026, it is recommended to pay particular attention to reviewing any relevant instructional notes in the Tabular List for applicable changes.
The list below highlights some of the significant 2027 updates to ICD-10-CM.
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The information contained in this coding advice is valid at the time of posting. Viewers are encouraged to research subsequent official guidance in the areas associated with the topic as they can change rapidly.