In this episode, Kristen Eglintine, BESLER’s Senior Manager Of Revenue Integrity Services, provides us with a glimpse into BESLER’s next webinar, Coding Updates for IPPS 2026, hosted live on Wednesday, September 24, at 1 PM ET.
Podcast (hfppodcast): Play in new window | Download
Learn how to listen to The Hospital Finance Podcast® on your mobile device.Highlights of this episode include:
- Key highlights and changes
- Coding changes in October of 2025
- Changes to procedure codes
- Summarization of NTAPs and Section X
- The new NTAPs for 2026
- MS-DRG changes this year
- How to prepare
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome back Kristen Eglintine, BESLER’s Senior Manager of Revenue Integrity Services of Coding and Projects. In this episode, Kristen will provide us with a glimpse into BESLER’s next free Webinar, Coding Updates for IPPS 2026, that we’re hosting live on Wednesday, September 24th, at 1 PM Eastern Time. Welcome back and thank you for joining us, Kristen.
Kristen Eglintine: Hi, Kelly, and hi everyone. Thank you for having me. I’m excited to be here.
Kelly: We’re excited to have you. Well, let’s go ahead and jump in. So, it’s that time once again to prepare for CMS’s annual IPPS update. The 2026 update contains several important components. Could you share a few of the key highlights and changes that we should be looking for?
Kristen: Absolutely. And you’re right. It is that time again. Fall is upon us. Summer’s over. So, we are ready for a new code set and some new guidelines. So, for this coming year, CMS has finalized a 2.6% payment increase for inpatient acute care hospitals, slightly above the 2.4% increase that was initially proposed back in April, which is great. LTACs are receiving a 2.7% base payment increase. And then after you factor in the high-cost outlier payments, it’s about a 3% overall update. So again, positive. The new Technology Add-On Payment Program is estimated to pay out an additional $192 million. CMS also implemented significant changes to quality reporting programs, including the removal of the COVID-19 exclusions and updates to readmission and value-based measures.
The final rule also advances the Mandatory Transforming Episode Accountability Model. And this was providing bundled payments for certain surgical procedures. That’s going to start January 1st of 2026. So, excited about that. And then finally, CMS also finalized its proposal to discontinue the low wage index hospital pricing for fiscal year 2026. So, this policy…it was established back in 2020. It provided budget-neutral wage index increases to hospitals that were in the bottom 25th percentile for wage index values. So, it benefited many rural and some small urban hospitals. This loss will be difficult for those. So, CMS does recognize that, and they’re going to implement a transitional exception policy to ease that impact on the affected hospitals. So, a little bad news, a little good news right there. But that’s a good summary of the upcoming changes we’ll see.
Kelly: Well, thank you for sharing those highlights with us. Sounds like it’s a busy year. So, what can we expect to see in terms of coding changes in October of 2025?
Kristen: So, the ICD-10-CM update is relatively large compared to last year’s update, nearly doubling the number of codes added. So, for this fiscal year, we have 74,350 total ICD-10-CM codes. There are 487 new codes, 28 deleted codes, with 38 revised codes. Some changes that we’ll see. So, we’ve got new codes coming for malignant inflammatory neoplasm of the breast, type 2 diabetes without complications in remission. And there’s an expansion of some multiple sclerosis codes. We’ll see a lot of changes in Chapter 12, which are diseases of the skin and subcutaneous tissue, with about 116 new codes. This includes a large expansion of non-pressure chronic ulcers.
There’s also an expansion and clarification for pain codes, especially pelvic pain around the R10 code set, replacing previous general codes. So, we have more precise location-based options. So, we’re seeing some specificity there. Around cardiac and vascular disorders. So, there’s expanded coding for acute myocardial infarction types, greater detail for the duration and severity. Through chapter 19, which is injury, poisoning, and other external causes, we will see a lot of changes, the most actually, about 213 new codes covering injury, laterality, depth, contusions, abrasions, blisters, bites, lacerations, etc. And then finally, some new codes for poisonings with antibiotics. And then there has been a slight expansion for adverse food reactions.
Kelly: Wow, that’s a great summary of changes to diagnosis codes. Thank you. Are there any changes to procedure codes as well?
Kristen: Yep, absolutely. So not quite as large as the diagnosis codes, but for the coming year, we will see about 156 new procedure codes. About 27 have been deleted. Most changes are for cardiac, neuro, and advanced therapeutic procedures. CMS added 57 new procedure codes to the intracranial vascular procedures logic list. So, this is enhancing the coding precision for neurovascular interventions. We have some new codes around joint replacements. So, there’s new qualifier characters in table 0RR for replacement of the left and right shoulder joints. And then also in the table 0SR for the left and right knee joints, and other updates for joint replacements. Bypass procedures also see some changes. So, we have new approach values and tables. And then, as always, we have many new technology codes which were added to Section X.
Kelly: All right. Thank you for that. Can you summarize NTAPs and Section X for us?
Kristen: Yeah. So, Kelly, that’s a great question because a lot of people and coders feel like they’re interchangeable, but not really. So NTAPs, new technology add-on payments, and the ICD-10 PCS Section X, they’re closely related, but not identical concepts in hospital reimbursement and coding. So NTAP is the payment program, and then Section X provides the PCS codes that hospitals must use to bill for the eligible NTAPs. Not all NTAPs are in Section X, though. Many are. And using the correct code is so important to receive that NTAP reimbursement. NTAPs generally end two to three years after they are approved by CMS. And then that code can either move to another section and is adapted into the code set, or it will just sunset.
Kelly: So, CMS approved 27 new NTAPs for fiscal year 2026. Can you highlight the new NTAPs for 2026 for us?
Kristen: Yeah. I really appreciate NTAPs. They encourage hospitals to adopt new innovative therapies and medical devices more quickly by providing additional reimbursement above the standard DRG rate. So, this translates to better patient care. Patients have earlier access to cutting-edge treatments. So NTAPs are amazing. Under the traditional pathway, CMS has approved five technologies. And under the alternative pathway, CMS has approved 22 technologies for fiscal year 2026. Some of the most notable and tapped approved technologies are– so in cardiovascular devices, we’ve got some drug-eluting balloons, pediatric vascular stents, and bioengineered blood vessel targeting vascular stenosis and arterial injuries. We have NTAPs in the implantable orthopedic device area. So, innovations such as the iFuse TORQ system, and that’s for the sacroiliac joint fusions and fracture fixations, diagnostic and monitoring technologies.
So, there’s some AI-driven clinical support tools. One example is sepsis AI marker. We have new technology add-on payments in the oncology and hematology therapies. Approvals include the CAR T-cell therapies and novel conditioning agents for stem cell transplants. Critical care and respiratory support systems also have an NTAP. And then we have other continuing or new NTAPs, such as some novel biologics, implantable devices, and then some other advanced therapies that will be receiving that additional payment on top of a DRG. So, in addition to the lung pacer AeroPace system, we do have other continuing or new NTAPs. Several of them are the novel biologics, implantable devices. There are diagnostic and advanced therapies, each reviewed for clinical improvement and cost. More details can be found in the official CMS fiscal year 2026 table. And that’s always available off of CMS’s website.
Kelly: Great. Thank you for providing that for us. Are there MS-DRG changes this year? And how might they affect clinical documentation and coding practices?
Kristen: We do. We have some changes to the DRG system this year. So key MS-DRG classification changes include updates to severity levels. So that is your CC or MCC designation. We do have new and modified DRGs for specific procedures and conditions. And then there’s always an annual recalibration of the relative weights. All of these changes impact clinical documentation and coding practices by requiring greater specificity in the documentation, paying careful attention to a CC or an MCC status, and then timely updates of coding and EHR templates. As far as new DRGs, so we have five for fiscal year 2026, which have been created for high complexity cases, such as MS-DRG 209. This is for complex aortic arch procedures.
MS-DRG 213 is new, and that is for endovascular abdominal interventions. And then we have three new MS-DRGs, 318, 359, and 360, for percutaneous coronary atherectomies with and without intraluminal devices. And these were created to better align reimbursement with cost. CMS, in addition to adding five new, deleted five. And those were for hypertensive encephalopathy and deep vein thrombophlebitis. They also deleted one surgical MS-DRG for arthroscopic procedures. There are also procedure-specific changes. So, the reassignment of chemotherapy and neurostimulator implants, they’ve been revised to MS-DRGs 20 to 24. Those will require updated coding workflows and more detailed operative notes as far as CDI’s work and documentation. And then I would say, large academic and tertiary centers, they’re probably the most impacted by these MS-DRG changes for fiscal year 2026. Facilities managing complex aortic arch surgeries or CAR T therapies, advanced cardiovascular procedures, and major oncology cases will see changes with new and reassigned MS-DRGs and altered payment rates.
Kelly: Great. Thank you for outlining those for us. Preparation is key to ensuring coders are ready for the fiscal year 2026 changes. Can you suggest how they can prepare?
Kristen: So first and foremost, stay informed and educated. Review official CMS updates, the rule summaries, attend webinars highlighting fiscal year 2026 IPPS changes, including new ICD-10-CM and PCS codes, the MS-DRG shifts, and NTAP approvals. This podcast is just an introduction to our upcoming webinar, which would greatly help any coder, validator, CDI prepare for the coding changes that we’ll see October 1st. And then again, that webinar is scheduled for Wednesday, September 24th at 1 PM Eastern Standard Time. And I strongly encourage and invite everyone to attend for a more detailed review of coding and the guideline changes that we can expect to see.
If you can’t attend the webinar, there are many resources available online. All coders and CDI should be familiar with them. Same places as last year. Additionally, the 2026 addendum reveals what changes occurred in the tabular list by each chapter. So that’s an easy way to find new, deleted, and revised ICD-10-CM codes. Also, as in years past, I strongly suggest coders or CDI download table five from CMS’s website. This is the finalized list of MS-DRGs. Table 6i and 6j are also very useful as well. They include ICD-10-CM diagnosis codes classified as MCCs and CCs. And then just, I can’t stress enough the importance of accurate documentation. Coders should be working closely with clinical staff to clarify documentation supporting the new diagnoses, procedures, CC, MCC designations, and the new technology for this up-and-coming year. I hope you find the upcoming changes as exciting as I do, and thank you for choosing to spend a few minutes of your day with us. I really enjoyed sharing this information with you, and I hope to see you all on our webinar.
Kelly: Yes, thank you so much for joining us, Kristen, and for giving this sneak peek into BESLER’s upcoming Webinar, Coding Updates from IPPS 2026 that you’re presenting live on Wednesday, September 24th at 1 PM Eastern Time, and as a bonus, you can earn one CEU. Thanks again, Kristen.
Kristen: Thank you. Have a nice day, everyone.
Kelly: And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
[music] This concludes today’s episode of The Hospital Finance Podcast. For show notes and additional resources to help you protect and enhance revenue at your hospital, visit besler.com/podcasts. The Hospital Finance Podcast is a production of BESLER | SMART ABOUT REVENUE, TENACIOUS ABOUT RESULTS.
If you have a topic that you’d like us to discuss on the Hospital Finance podcast or if you’d like to be a guest, drop us a line at update@besler.com.
