Updates to ICD-10 codes for diabetes
And lastly there is great news on the horizon. Out of the hundreds of codes with this release, probably the most notable and exciting is a single code found in Chapter 4: Endocrine, Nutritional, and Metabolic Diseases. E11.A – Type 2 diabetes mellitus without complications in remission. Diabetes can now officially be documented as being in remission, classified by sustaining normal blood glucose levels for three months or more! While remission may have always been possible, it's likely becoming more common, and now there's a way to reflect this important clinical detail in the patient record.
This development raises an interesting question: is this shift due to the rise of GLP-1 medications, or are other factors at play? With this new classification, clinical decision support rules will need to be updated, as the guidelines for managing patients in remission will likely differ from those with active diabetes. Additionally, population cohort definitions must be revised to ensure they accurately include or exclude patients based on this new remission status within the diabetes diagnosis.
Impacts of the 2026 ICD-10 updates
Why are these updates important?
- Compliance with CMS regulations: Not adopting the new codes can lead to compliance risks.
- Better patient care: Updated codes ensure accurate diagnosis and treatment planning.
- Streamlined operations: Latest codes reduce errors in claims and analytics.
Healthcare organizations should act quickly to integrate these updates and avoid disruptions. The 2026 updates won’t just touch upon one part of the healthcare ecosystem; they have widespread implications across key functions, including:
Billing and claims processing: Implementing the new ICD-10 codes correctly is critical to avoiding delays or denials in claims. A missed update could delay payment cycles, as was the case for a large payer in a prior year. Without preparation, they couldn’t process claims by the October 1 deadline, causing costly operational pain points.
Medical documentation: Accurate, up-to-date medical documentation ensures that patient care plans reflect their most current health challenges. For instance, the addition of codes for specific allergies will refine clinical decision-making and reduce safety risks, preventing treatments that could trigger harmful reactions.
Healthcare analytics: The granularity and specificity of new ICD-10 codes fuel precise data analysis. This is vital for tracking population health trends, enhancing risk stratification, and developing value-based care initiatives.
Reporting and compliance: Coding accuracy is a foundational element of compliance with healthcare regulations. Many payer organizations rely on timely ICD updates for accurate patient-data reporting, which has direct implications for reimbursement and compliance audits.
Best practices for adopting ICD-10 updates
While these updates bring benefits, they also introduce complexity. Updating thousands or tens of thousands of clinical decision support rules, medical policy code groups, or value sets underpinning analytics can be daunting. To ensure smooth implementation of the 2026 ICD-10 updates, organizations should focus on strategic readiness and the appropriate tooling. Here are some proven best practices:
Conduct training sessions: Educate coders, physicians, and billing staff about the updates. Ensure teams understand how changes apply to their specific workflows, improving coding accuracy. Online training modules and CMS resources can be valuable tools.
Automate processes: Traditional methods of updating codes like spreadsheets or generic MDM tools are time consuming and error-prone, lacking the domain-specific knowledge required. Healthcare solutions like the Health Language Platform can help automate ICD-10 updates, reducing processing time for updating affected value sets by up to 90%.
Perform regular audits: Conduct internal audits to identify gaps in your current coding workflows. Use these insights to improve data accuracy, compliance, and operational resilience.
Leverage advanced tools:
Adopt healthcare terminology platforms that streamline coding updates. These platforms highlight the specific code groups affected by updates, helping organizations focus efforts where they’re most needed.
Real-world example:
A life insurance company with over 6,000 code groups, previously faced 162 hours of manual work to review updates. With a robust solution, they reduced this task to just 25 minutes for the 2026 ICD-10 updates, enabling them to process updates efficiently and meet compliance requirements.
Strengthen workflows for ICD-10 updates
The clock is ticking toward October 1, 2025, and preparation is critical. Staying ahead of the 2026 ICD-10 updates means more than just compliance; it’s about strengthening operations and ensuring better outcomes for patients, providers, and payers alike.
By addressing these updates proactively, your organization not only avoids disruptions but also positions itself as a leader in operational efficiency and patient care. We’re here to help you navigate these changes and make the updates as painless as possible for your organization. Reach out today to speak to healthcare data expert.
