Background  

The International Classification of Diseases, Tenth Revision (ICD-10) Coordination & Maintenance (C&M) Committee meetings are held each spring and fall. Traditionally, the Centers for Medicare & Medicaid Services (CMS) leads discussions on revisions to the ICD-10-Procedure Coding System code set, while the US Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) leads discussions on the ICD-10-Clinical Modification (CM) diagnosis code set. Each agency is responsible for maintaining its respective code set.   

Since 2025, only ICD-10-CM diagnosis codes have been discussed during virtual public meetings. Public input is encouraged both during the sessions and through written comments afterward. Public comments are shared only with the submitter of the respective proposal and not with the general public. Any approved code changes discussed at the March meeting will take effect on either October 1, 2026, April 1, 2027, or October 1, 2027.  

The C&M Committee meetings continue to be an open forum to discuss proposals for revisions to the ICD-10-CM code set and are an invaluable opportunity to keep abreast of and participate in the shaping of this code set. 

Codes for Genetic Conditions 

NCHS started the meeting by announcing that current proposals related to ultra-rare conditions and diseases with gene-level specificity will be on hold until CDC/NCHS establishes organizing principles to ensure that such proposals can move forward efficiently and effectively. NCHS specified that there are currently no organizing factors for genetic conditions in ICD-10-CM, and that these conditions can be found in various ways and across different chapters of the code set. NCHS identified several concerns that further amplify the issue, including complexity and rate of research and evidence updates, lack of standardization to organize and identify gene-disease data, delays and ambiguity in code reviews, data inconsistency and lack of organizational strategy, and structural constraints due to the plethora of genetic mutations and gene-disease relationships. As such, NCHS is seeking input to guide the development of principles that clarify the ICD-10-CM scope and process for incorporating, applying, and maintaining codes for genetic conditions, and anticipates resuming acceptance of code proposals for ultra-rare or genetic conditions with those newly established principles to be discussed at the March 2027 ICD-10 C&M Committee meeting.   

Summary of Proposed Changes   

The latest ICD-10-CM proposals introduce new codes spanning disease areas such as carotid web, Wolff-Parkinson-White syndrome, congenital hyperinsulinism, adverse effects of COVID-19 vaccines, biomarkers for Alzheimer’s disease, hypertriglyceridemia, sepsis. These updates aim to enhance the current classification system, ensure accurate diagnosis and tracking of epidemiological data, improve patient outcomes, and reduce misclassification across conditions with significant clinical and public health impact. 

Other topics that prompted discussion include codes for: 

Sepsis: In 2019, the proposed changes to the consensus definitions for Sepsis-3 did not move forward due to public concerns that the proposed definition would not capture patients with severe infections but without yet organ dysfunction, leading to poorer or inappropriate treatment and potentially adverse outcomes. To address the previous gap, this year’s proposal expands the existing sepsis codes by organism to identify sepsis and impending sepsis. Requestors also proposed creating codes to identify organ dysfunction and deleting the severe sepsis code, in alignment with Sepsis-3 definitional changes. The NCHS noted that it plans to present a complete proposal in September and requested additional public input on this topic. 

Biomarkers for Alzheimer’s disease (AD): A  proposal for codes to identify abnormalities in biomarkers for AD was first presented at the September 2025 ICD-10 C&M meeting. Subsequent public comments were taken into consideration and current tabular modifications reflect updates based on those. Biomarkers play a major role in detecting the underlying pathology of AD. Amyloid plaques and tau tangles are key features that can now be reliably detected with PET scans and radiotracers decades before clinical symptoms present. While there is general agreement that these biomarkers are potentially significant, there is discussion around whether they should be interpreted as early disease or a risk factor for AD. Currently, there are no specific codes for Alzheimer’s biomarkers. Proponents argue these codes are necessary to avoid misuse of diagnostic codes for Alzheimer’s, accurately identify patients for future clinical evaluations and management, and identify potential clinical trial participants. Tabular modifications include adding new codes for abnormalities in biomarkers in plasma protein, cerebrospinal fluid, and PET scans. 

Controlled obesity: Attendees discussed a proposed code  for controlled obesity, which was defined by the presenter as: “Patients with a history of diabetes with improvements in weight and BMI, but the underlying pathophysiology of obesity remains.” Despite weight control, patients with obesity require continued monitoring and treatment and remain at risk for other comorbidities and ongoing metabolic challenges. Therefore, a code for history of obesity would not fully capture the ongoing clinical disease management and risk factors. Meeting attendees expressed concerns about clinical definitions and the current use of this term in medical record documentation. Further, these proposed changes reflect the concept that obesity is commonly an ongoing multifactorial chronic disease that can be controlled but may not necessarily be cured.  

Public Comment Deadlines 

Public comment is open through April 17, 2026 for the following codes, to be implemented October 1, 2026: 

• Gender Identity Disorder, in remission: Transition and Detransition Codes
• Medetomidine Withdrawal Syndrome 

Public comments are due by May 15, 2026, for codes considered for implementation on April 1, 2027, or October 1, 2027. Codes finalized after the public comment period will be included in Table 6A of the FY 2028 Inpatient Prospective Payment System Proposed Rule, which CMS is expected to release around April 2027. Codes not finalized may be discussed again during the fall 2026 ICD-10 C&M Committee meeting.    

The public may submit requested topics for the fall 2026 meeting through June 5, 2026. Diagnosis code requests should be directed to NCHS. During the fall 2025 meeting, moderators announced that new guidance on the ICD-10-CM Proposal Process for diagnosis-related proposal submissions would be released mid-October; however, the guidance was not posted. During the March 2026 meeting, moderators stated that new guidance outlining what should be included in an ICD-10-CM code request submission would be shared imminently.  

Stakeholder Impacts of New Codes  

The introduction of new ICD-10-CM codes can have various impacts on stakeholders across the healthcare system:  

• Manufacturers: Must adjust market access and reimbursement strategies to align with new codes and shifting demand.  

• Providers: Need to update diagnosis and billing practices, with possible training and electronic health record adjustments affecting workflows, prior authorizations, and reimbursement.  

• Health Plans: May revise medical necessity logic, coverage, and rates, impacting cost management and actuarial planning.  

• Patients: Could see changes in access, treatment options, and out-of-pocket costs depending on coverage shifts.  

• Policymakers: Can leverage updated coding data for surveillance, resource allocation, and policy development. 

Partner With Us  

Avalere Health brings deep coding, clinical, and market expertise to help manufacturers navigate strategic code applications and translate reimbursement strategies into improved patient access. Our team actively monitors coding developments—regularly attending CMS and CDC meetings—to capture real-time insights and anticipate shifts in the reimbursement landscape. By staying ahead of these changes, we partner with life sciences companies to enhance patient access and health outcomes. To learn more about how Avalere Health can assist you, please connect with us.