How Medical Billers Can Prepare For The FY 2026 ICD-10-CM Updates

Understanding The Major FY 2026 Guideline Changes

Before changing workflows or re-training your team, it helps to know what’s actually different this time around. For FY 2026, the updates focus on improving clarity and accuracy for conditions that are commonly miscoded or documented inconsistently.

HIV Sequencing Updates

One of the most important areas involves HIV sequencing. There are clearer rules about when HIV should be listed as the primary diagnosis and when it should be sequenced after another condition. Sequencing errors are a leading cause of denials, so this update is especially important for billing compliance efforts.

Type 2 Diabetes In Remission

This year, “remission” isn’t just a loose term anymore. Providers who previously used general wording like “improved” or “controlled” will need to adjust their language. Billers must ensure that documentation supports the new, more specific codes – an essential step in ICD-10 2026 preparation.

Conditions Affecting Multiple Sites

There are also updated rules around coding conditions that affect multiple sites. This especially affects musculoskeletal issues, injuries, dermatology codes, and certain chronic conditions. Providers will need to be more specific when describing exactly where the issue is occurring, especially if more than one area of the body is involved. Without this level of detail, billers may be forced to use unspecified codes – something payers are becoming far less flexible about. 



Getting familiar with these changes now makes your job considerably easier later on. And if you are using billrMD’s ICD-10 compliant billing software, many of these guideline updates automatically appear in the system as you work, which helps reduce the chances of using outdated or incorrect codes.

Avoiding Common Pitfalls During ICD-10 Transitions

Every year, when a new ICD-10 update rolls out, the same types of billing issues tend to pop up. The good news is that most of them are completely avoidable if you plan ahead of time.

One of the biggest issues happens when practices accidentally use deleted codes after the new update begins. Since deleted codes become invalid immediately on October 1, even a single outdated code can cause a claim rejection. This can be a major headache for practices still using older billing systems that require manual updates. A cloud-based medical billing software for ICD-10, like billrMD, eliminates this problem completely because it automatically updates its code library, so you never run the risk of submitting outdated codes.

Another common challenge is documentation. The 2026 updates require more specific provider documentation, as missing details often lead to unnecessary denials. Giving providers early notice about upcoming requirements strengthens billing compliance and reduces back-and-forth communication.

Practices using outdated platforms often struggle with uninstalled updates or mismatched code sets. This isn’t a problem for those using billrMD, as its system eliminates manual updates by automating all coding changes, keeping your practice management software fully aligned with ICD-10.



And finally, there’s the issue of unspecified codes. Payers continue to tighten their expectations, and unspecified coding is one of the top reasons claims get denied during the first few months of a new ICD-10 cycle. The 2026 changes regarding multi-site documentation make this even more important. billrMD’s built-in medical billing automation tools help reduce these denials by identifying when documentation is incomplete and flagging missing details before the claim is submitted.

A Practical, Real-World ICD-10 Readiness Plan For FY 2026

Let’s walk through what your game plan should look like both before and after October 1, 2025. Instead of another checklist full of bullet points, here’s a narrative version you can read straight through and apply immediately.

Preparing Before October 1, 2025

Ensure your medical billing software is fully prepared for the FY 2026 ICD-10 changes. If your system requires manual updates, schedule them ahead of time. Platforms like billrMD update ICD-10 and CPT codes automatically every year.

Get the FY 2026 ICD-10 files from CMS or the CDC, including code lists, guidelines, and addenda. Reviewing these documents helps your team understand what’s new and why.

Take a look at the diagnosis codes your practice uses most often. Every specialty has its “top 50” diagnosis codes, and this is where changes can impact your daily workflow the most. For example, primary care clinics may need to identify chronic condition codes, while podiatry, chiropractic, and optometry practices will want to check musculoskeletal and injury-related updates. 



billrMD can help identify your most frequently used codes so you don’t have to dig through reports manually.

Once you’ve reviewed the changes, it’s time for team training. You don’t need to run long classroom-style sessions – short, simple training blocks work just as well. Go over the key documentation updates, review the major code changes, and give everyone time to ask questions. If you’re using billrMD, its intuitive interface and automation tools help shorten the learning curve, especially when learning how to prepare for ICD-10-CM 2026 updates.

What To Do After October 1, 2025

Review claims submitted in the first 30 days for sequencing errors, outdated codes, or missing documentation. Early detection prevents small issues from escalating.

Watch for recurring claim denials and address them promptly. billrMD’s reporting features make it easier to spot patterns quickly.

Build an easy-to-read list of the most important code changes affecting your specialty. billrMD can generate code usage reports to simplify this process.

Maintain regular discussions among billers, coders, and providers to resolve uncertainties. Open communication during the first few months reduces the risk of compliance issues.

How billrMD Makes ICD-10 Preparation Easier

Technology plays a huge role in how smoothly ICD-10 transitions go, and this is where billrMD really stands out. Since the system is cloud-based, practices never have to install updates manually or worry about outdated code libraries. The platform updates automatically and quietly in the background, which means your entire ICD-10 transition happens with far less effort and far fewer risks. 

billrMD also reduces errors with built-in medical billing automation tools that check eligibility, scrub claims, and flag common claim and documentation-related issues before submission.  As coding rules become more complex each year, automation and compliance play an important role in reducing denials and rework.

Because billrMD functions as a full revenue cycle management system, it supports everything from patient intake to collections. This makes annual transitions, such as ICD-10 updates, much easier because the entire workflow is connected rather than scattered across multiple systems.

And on top of that, billrMD’s user-friendly design helps teams adapt quickly. Whether you have experienced billers or new staff members, the system makes it easier to handle coding changes, manage documentation updates, and keep claims clean.

Start Early, Stay Organized, And Make Compliance Easier

Preparing for the FY 2026 ICD-10-CM update doesn’t have to be stressful. When you begin early, communicate clearly, and use tools that support automation and compliance, the transition not only becomes manageable but also much smoother than you might expect.

The key steps are simple: Understand the changes, prepare your team, update your software, review documentation, and keep an eye on your claims during the first few weeks after October 1. And if you want a system that makes all of this significantly easier, billrMD offers the automation, clarity, and compliance tools that modern practices need. 



To stay ahead of coding changes and keep your billing processes running smoother than ever, you can always explore more resources from us.

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