The FY2026 ICD-10-CM guidelines are out and include updated language around coding for patients with human immunodeficiency virus (HIV) infections, hypertension/heart disease and antineoplastic chemotherapy.
The guidelines take effect Oct. 1, along with the finalized FY2026 code set.
Updated guidelines for “HIV disease” can be found in under Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99) at I.C.1.a.2)(a) and advise:
- If the term “AIDS” or “HIV disease” is documented or if the patient is treated for any HIV-related illness or is described as having any condition(s) resulting from the patient’s HIV positive status; code B20, Human immunodeficiency virus [HIV], should be assigned.
This is just one of several changes made to the guidelines around HIV coding, including updated language at I.C.1.a.2)(e) for asymptomatic human immunodeficiency virus to state:
- When “HIV positive,” “HIV test positive,” or similar terminology is documented, and there is no documentation of symptoms or HIV-related illness, code Z21, Asymptomatic human immunodeficiency virus [HIV] infection status, should be assigned.
Other updates from the guidelines:
- A change to coding for admissions/encounters involving antineoplastic chemotherapy is also included at I.C.2.e.2) to state (see bold for changes):
- If a patient admission/encounter is chiefly for the administration of chemotherapy, immunotherapy or external beam radiation therapy for the treatment of a neoplasm, assign code Z51.0, Encounter for antineoplastic radiation therapy, or Z51.11, Encounter for antineoplastic chemotherapy, or Z51.12, Encounter for antineoplastic immunotherapy as the first-listed or principal diagnosis. If the reason for the encounter is more than one type of antineoplastic therapy, code Z51.0 and codes from subcategory Z51.1 may be assigned together, in which case one of these codes would be reported as a secondary diagnosis.
- Updates were also made under Chapter 9: Disease of the Circulatory System (I00-I99). For example, at I.C.9.a.1) for Hypertension with Heart Disease, the coding guidelines will now read (see bold for changes):
- Hypertension with heart conditions classified to I50.-, Heart failure, I51.4, Myocarditis, unspecified, I51.89, Other ill-defined heart diseases, and I51.9, Heart disease, unspecified, is assigned to a code from category I11, Hypertensive heart disease. Use additional code(s) from category I50, Heart failure, or I51, Complications and ill-defined descriptions of heart disease, to identify the heart condition.
Hypertension with heart conditions classified to I51.5, Myocardial degeneration, or I51.7, Cardiomegaly, is assigned to a code from category I11, Hypertensive heart disease. No additional code is assigned to identify the specific heart condition.
The same heart conditions (I50.-, I51.4-I51.7, I51.89, I51.9) with hypertension are coded separately if the provider has documented they are unrelated to the hypertension. The applicable hypertension code I10, Essential (primary) hypertension, or a code from category I15, Secondary hypertension, should be assigned. Sequence according to the circumstances of the admission/encounter.
- A new guideline for under Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99) for multiple sites was added at I.C.13.a.2) and states:
- Codes describing specified sites are assigned individually by site when documented. When the specified site(s) are not documented, assign the appropriate code for “multiple sites.”