Check the FY 2026 ICD-10-CM tabular addenda for changes to existing codes

by Julia Kyles, CPC

Review the FY2026 ICD-10-CM tabular addenda for codes that you regularly report so you don’t miss additional information that can augment coding through more guidance or alert you to potential pitfalls. 

For example, the tabular addenda for the FY2026 update contains four new “Code first notes,” 10 new “Use additional code” notes, 11 new “Code also” notes, 23 new Excludes1 notes and 30 new Excludes2 notes.

Check chapters that weren’t updated

Start your review with changes to chapters 10 (Diseases of the respiratory system [J00-J99]) and 11 (Diseases of the digestive system [K00-K95]). There are no new, revised or deleted codes in these chapters, but in chapter 10 you’ll find an Excludes note switch for J43 (Emphysema). The Excludes1 note that stops you from coding it and J68.4 (Emphysema due to inhalation of chemicals, gases, fumes or vapors) for the same encounter will become an Excludes2 note effective October 1, 2025.

“When an Excludes2 note appears under a code, it is acceptable to use both the code and the excluded code together, when appropriate,” according to the ICD-10-CM guidelines.

Another Excludes note switch for J44 (Other chronic obstructive pulmonary disease) will allow coders to report the code with J42 (Unspecified chronic bronchitis) along with codes from the simple and mucopurulent chronic bronchitis group (J41.-).

A revision for J84.1 (Other interstitial pulmonary diseases with fibrosis) changes an Excludes1 note for J68.4 (Chronic respiratory conditions due to chemicals, gases, fumes and vapors) to a Code Also note, which means it should be coded when applicable. According to the guidelines, the “note instructs that two codes may be required to fully describe a condition, but this note does not provide sequencing direction. The sequencing depends on the circumstances of the encounter.”

In chapter 11, you’ll find new inclusion terms. Metabolic dysfunction-associated steatohepatitis (MASH) has been added as an inclusion term under K75.81 (Nonalcoholic steatohepatitis [NASH]), and metabolic dysfunction-associated steatotic liver disease (MASLD) is listed as an inclusion term for K76.0 (Fatty [change of] liver, not elsewhere classified).

Watch for new Excludes1 notes

New Excludes1 notes for existing codes are scattered throughout the updated tabular. If a practice was able to report both codes in the past, they will not be able to after Sept. 30. For example, hypertensive heart disease with heart failure (I11.0) and without heart failure (I11.9) and codes in the hypertensive heart and chronic kidney disease group (I13.-) will be added as Excludes1 codes for I51.5 (Myocardial degeneration) and I51.7 (Cardiomegaly), which is enlargement of the heart.

Here are three more Excludes1 notes:

1. Check R40.2A (Nontraumatic coma due to underlying condition) for new Excludes1 notes that block pairing the code with codes from the eyes open (R40.21.-), best verbal response (R40.22.-), total score (R40.23.-) and best motor response (R40.24.-) groups.
2. You’ll find a new Excludes1 code for R65.21 (Severe sepsis with septic shock), which blocks reporting the severe sepsis code with a postprocedural septic shock code (T81.12-)
3. In chapter 19 (Injury, poisoning and certain other consequences of external causes [S00-T88]), S37.6 (Injury of uterus) received a new Excludes1 code that blocks reporting the diagnosis with codes from the O9A.2- group (Injury, poisoning and certain other consequences of external causes complicating pregnancy, childbirth and the puerperium).

DIY: How to search the tabular addenda

The PDF of the tabular addenda includes a list of bookmarks, which allows you to quickly navigate through the changes in each chapter. You’ll find a complete list of most additions and deletions by searching for “add” or “delete,” plus the term for the note you want to see. For example, if you want to see all of the new “Code first” notes, such as the addition of blood disease codes D56.-, D58.2 and D75.9 to the code also list for M36.3 (Arthropathy in other blood disorders), you would search for AddCode first. Do not put a space between “Add” and “Code.”

You can repeat the process for any other update that is flagged with a term for the note, such as DeleteExcludes1, which will show you the 17 Excludes1 notes that will be deleted effective Oct. 1. Changes to inclusion terms are not flagged with a specific term, so you will need to conduct a chapter-by-chapter review using the bookmarks in the document.

Editor’s note: This article originally appeared in Part B News.