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ICD-10-CM Official Guidelines for Coding and Reporting
FY 2026 — UPDATED October 1, 2025
Comprehensive coding guidelines for healthcare professionals covering October 1, 2025 - September 30, 2026
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Introduction
ICD-10-CM Official Guidelines for Coding and Reporting FY 2026
UPDATED October 1, 2025 (October 1, 2025 - September 30, 2026)
Narrative changes appear in bold text
Items underlined have been moved within the guidelines since the April 2025, FY 2025 version
Italics are used to indicate revisions to heading changes
The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), two departments within the U.S. Federal Government's Department of Health and Human Services (DHHS) provide the following guidelines for coding and reporting using the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM). These guidelines should be used as a companion document to the official version of the ICD-10-CM as published on the NCHS website. The ICD-10-CM is a morbidity classification published by the United States for classifying diagnoses and reason for visits in all health care settings. The ICD10-CM is based on the ICD-10, the statistical classification of disease published by the World Health Organization (WHO).
These guidelines have been approved by the four organizations that make up the Cooperating Parties for the ICD-10-CM: the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and NCHS.
These guidelines are based on the coding and sequencing instructions in the Tabular List and Alphabetic Index of ICD-10-CM, but provide additional instruction. Adherence to these guidelines when assigning ICD-10-CM diagnosis codes is required under the Health Insurance Portability and Accountability Act (HIPAA). The diagnosis codes (Tabular List and Alphabetic Index) have been adopted under HIPAA for all healthcare settings. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures. These guidelines have been developed to assist both the healthcare provider and the coder in identifying those diagnoses that are to be reported. The importance of consistent, complete documentation in the medical record cannot be overemphasized. Without such documentation accurate coding cannot be achieved. The entire record should be reviewed to determine the specific reason for the encounter and the conditions treated.
The term encounter is used for all settings, including hospital admissions. In the context of these guidelines, the term provider is used throughout the guidelines to mean physician or any qualified health care practitioner who is legally accountable for establishing the patient's diagnosis.
Only this set of guidelines, approved by the Cooperating Parties, is official.
The guidelines are organized into sections. Section I includes the structure and conventions of the classification and general guidelines that apply to the entire classification, and chapter-specific guidelines that correspond to the chapters as they are arranged in the classification. Section II includes guidelines for selection of principal diagnosis for non-outpatient settings. Section III includes guidelines for reporting additional diagnoses in non-outpatient settings. Section IV is for outpatient coding and reporting. It is necessary to review all sections of the guidelines to fully understand all of the rules and instructions needed to code properly.
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Table of Contents
Guidelines Structure
ICD-10-CM Official Guidelines for Coding and Reporting
Section I. Conventions, general coding guidelines and chapter specific guidelines
A. Conventions for the ICD-10-CM
  1. The Alphabetic Index and Tabular List
  1. Format and Structure:
  1. Use of codes for reporting purposes
  1. Placeholder character
  1. 7th Characters
  1. Abbreviations
  • a. Alphabetic Index abbreviations
  • b. Tabular List abbreviations
  1. Punctuation
  1. Use of "and"
  1. Other and Unspecified codes
  • a. "Other" codes
  • b. "Unspecified" codes
  1. Includes Notes
  1. Inclusion terms
  1. Excludes Notes
  • a. Excludes1
  • b. Excludes2
  1. Etiology/manifestation convention ("code first", "use additional code" and "in diseases classified elsewhere" notes)
  1. "And"
  1. "With"
  1. "See" and "See Also"
  1. "Code also" note
  1. Default codes
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Section I Continued
Code Assignment and Clinical Criteria
01
Code assignment and Clinical Criteria
B. General Coding Guidelines
The general coding guidelines provide essential instructions for proper code assignment across all healthcare settings and conditions.
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General Guidelines
General Coding Guidelines
1
Locating a code in the ICD-10-CM
Begin with the Alphabetic Index and verify in the Tabular List
2
Level of Detail in Coding
Use the highest level of specificity available
3
Code or codes from A00.0 through T88.9, Z00-Z99.8, U00-U85
Comprehensive code range coverage
4
Signs and symptoms
Report when no definitive diagnosis is established
5. Conditions that are an integral part of a disease process
Do not code conditions that are inherent to the disease
6. Conditions that are not an integral part of a disease process
Code additional conditions separately when present
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Additional General Coding Guidelines
7. Multiple coding for a single condition
Use multiple codes when instructed by the classification
8. Acute and Chronic Conditions
Sequence acute before chronic when both are documented
9. Combination Code
Use a single code when it fully describes the condition
10. Sequela (Late Effects)
A sequela is the residual effect (condition produced) after the acute phase of an illness or injury has terminated. There is no time limit on when a sequela code can be used. The residual may be apparent early, such as in cerebral infarction, or it may occur months or years later, such as that due to a previous injury.
11. Impending or Threatened Condition
Code as confirmed unless otherwise directed
12. Reporting Same Diagnosis Code More than Once
Report only once unless classification instructs otherwise
13. Laterality
Specify right, left, bilateral, or unspecified side
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Documentation and Reporting Guidelines
14. Documentation by Clinicians Other than the Patient's Provider
Code based on documentation from any qualified healthcare practitioner who is legally accountable for establishing the patient's diagnosis
15. Syndromes
Follow the Alphabetic Index guidance when coding syndromes. In the absence of index guidance, assign codes for documented manifestations of the syndrome
16. Documentation of Complications of Care
Code assignment is based on the provider's documentation of the relationship between the condition and the care or procedure
17. Borderline Diagnosis
If the provider documents a "borderline" diagnosis at the time of discharge, the diagnosis is coded as confirmed, unless the classification provides a specific entry (e.g., borderline diabetes). If a borderline condition has a specific index entry in ICD-10-CM, it should be coded as such. Since borderline conditions are not uncertain diagnoses, no distinction is made between the care setting (inpatient versus outpatient). Whenever the documentation is unclear regarding a borderline condition, coders are encouraged to query for clarification.
18. Use of Sign/Symptom/Unspecified Codes
Sign/symptom and "unspecified" codes have acceptable, even necessary, uses. While specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient's health condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the healthcare encounter. Each healthcare encounter should be coded to the level of certainty known for that encounter.
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Special Circumstances
Coding for Healthcare Encounters in Hurricane Aftermath
1. Coding for Healthcare Encounters in Hurricane Aftermath
a. Use of External Cause of Morbidity Codes
An external cause of morbidity code should be assigned to identify the cause of the injury(ies) incurred as a result of the hurricane. The use of external cause of morbidity codes is supplemental to the application of ICD-10-CM codes. External cause of morbidity codes are never to be recorded as a principal diagnosis (first-listed in non-inpatient settings). The appropriate injury code should be sequenced before any external cause codes. The external cause of morbidity codes capture how the injury or health condition happened (cause), the intent (unintentional or accidental; or intentional, such as suicide or assault), the place where the event occurred, the activity of the patient at the time of the event, and the person's status (e.g., civilian, military). They should not be assigned for encounters to treat hurricane victims' medical conditions when no injury, adverse effect or poisoning is involved. External cause of morbidity codes should be assigned for each encounter for care and treatment of the injury. External cause of morbidity codes may be assigned in all health care settings. For the purpose of capturing complete and accurate ICD-10-CM data in the aftermath of the hurricane, a healthcare setting should be considered as any location where medical care is provided by licensed healthcare professionals.
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Hurricane Aftermath Coding Continued
b. Sequencing of External Causes of Morbidity Codes
Codes for cataclysmic events, such as a hurricane, take priority over all other external cause codes except child and adult abuse and terrorism and should be sequenced before other external cause of injury codes. Assign as many external cause of morbidity codes as necessary to fully explain each cause. For example, if an injury occurs as a result of a building collapse during the hurricane, external cause codes for both the hurricane and the building collapse should be assigned, with the external causes code for hurricane being sequenced as the first external cause code. For injuries incurred as a direct result of the hurricane, assign the appropriate code(s) for the injuries, followed by the code X37.0-, Hurricane (with the appropriate 7th character), and any other applicable external cause of injury codes. In addition to code X37.0-, Hurricane, other possible applicable external cause of morbidity codes include: W54.0-, Bitten by dog Y92.-, Place of occurrence X30.-, Exposure to excessive natural heat X31.-, Exposure to excessive natural cold, and X38.-, Flood.
c. Other External Causes of Morbidity Code Issues
For injuries that are not a direct result of the hurricane, such as an evacuee that has incurred an injury as a result of a motor vehicle accident, assign the appropriate external cause of morbidity code(s) for the injury, but do not assign code X37.0, Hurricane. If it is not clear whether the injury was a direct result of the hurricane, assume the injury is due to the hurricane and assign code X37.0-, Hurricane, as well as any other applicable external cause of morbidity codes. In addition to code X37.0-, Hurricane, assign code Y38.-, Terrorism, and any other applicable external cause of morbidity codes if the injury is the result of a terrorist event.
d. Use of Z codes
Z codes (other reasons for healthcare encounters) may be assigned as appropriate to further explain the reasons for presenting for healthcare services, including transfers between healthcare facilities, or provide additional information relevant to a patient encounter. The ICD-10-CM Official Guidelines for Coding and Reporting identify which codes maybe assigned as principal or first-listed diagnosis only, secondary diagnosis only, or principal/first-listed or secondary (depending on the circumstances). Possible applicable Z codes include:
  • Z59.0, Homelessness
  • Z59.1, Inadequate housing
  • Z59.5, Extreme poverty
  • Z75.1, Person awaiting admission to adequate facility elsewhere
  • Z75.3, Unavailability and inaccessibility of health care facilities
  • Z75.4, Unavailability and inaccessibility of other helping agencies
  • Z76.2, Encounter for health supervision and care of other healthy infant and child
  • Z99.12, Encounter for respirator [ventilator] dependence during power failure
The external cause of morbidity codes and the Z codes listed above are not an all-inclusive list. Other codes may be applicable to the encounter based upon the documentation. Assign as many codes as necessary to fully explain each healthcare encounter. Since patient history information may be very limited, use any available documentation to assign the appropriate external cause of morbidity and Z codes.
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Chapter 1
Chapter-Specific Coding Guidelines
C. Chapter-Specific Coding Guidelines
1. Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99), U07.1, U09.9
a. Human Immunodeficiency Virus (HIV) Infections
Comprehensive guidelines for coding HIV-related conditions and encounters
b. Infectious agents as the cause of diseases classified to other chapters
Proper sequencing and reporting of infectious agents
c. Infections resistant to antibiotics
Documentation and coding of antibiotic-resistant infections
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Chapter 1 Guidelines Continued
d. Sepsis, Severe Sepsis, and Septic Shock Infections resistant to antibiotics
Detailed coding instructions for sepsis-related conditions including proper sequencing and documentation requirements
e. Methicillin Resistant Staphylococcus aureus (MRSA) Conditions
Specific guidelines for identifying and coding MRSA infections and colonization
f. Zika virus infections
Coding guidelines for Zika virus and related complications
g. Coronavirus infections
Comprehensive COVID-19 and coronavirus coding instructions
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Chapter 2
Neoplasms Coding Guidelines
1. Chapter 2: Neoplasms (C00-D49)
Chapter 2 provides comprehensive guidelines for coding neoplasms, including malignant, benign, and uncertain behavior neoplasms.
Key Topics Covered:
  • a. Admission/Encounter for treatment of primary site
  • b. Admission/Encounter for treatment of secondary site
  • c. Coding and sequencing of complications
  • d. Primary malignancy previously excised
  • e. Admissions/Encounters involving chemotherapy, immunotherapy and radiation therapy
  • f. Admission/encounter to determine extent of malignancy
  • g. Symptoms, signs, and abnormal findings listed in Chapter 18 associated with neoplasms
  • h. Admission/encounter for pain control/management
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Neoplasms Guidelines Continued
i. Malignancy in two or more noncontiguous sites
Guidelines for coding multiple primary malignant neoplasms
j. Disseminated malignant neoplasm, unspecified
Use when primary site cannot be determined
k. Malignant neoplasm without specification of site
Coding when site is not documented
l. Sequencing of neoplasm codes
Proper order of code assignment for neoplasms
m. Current malignancy versus personal history of malignancy
When a primary malignancy has been excised but further treatment is directed to that site, the primary malignancy code should be used until treatment is completed.
n. Leukemia, Multiple Myeloma, and Malignant Plasma Cell Neoplasms in remission versus personal history
Specific guidelines for hematologic malignancies in remission
o. Aftercare following surgery for neoplasm
p. Follow-up care for completed treatment of a malignancy
q. Prophylactic organ removal for prevention of malignancy
s. Breast Implant Associated Anaplastic Large Cell Lymphoma
Specific coding instructions for this rare condition associated with breast implants.
t. Secondary malignant neoplasm of lymphoid tissue
Guidelines for coding secondary malignancies involving lymph nodes and lymphoid tissue.
Chapter 3
Blood and Immune System Disorders
1. Chapter 3: Disease of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89)
Reserved for future guideline expansion
This chapter covers diseases of the blood and blood-forming organs, as well as certain disorders involving the immune mechanism. Specific guidelines for this chapter are reserved for future expansion as coding practices evolve.
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Chapter 4
Endocrine, Nutritional, and Metabolic Diseases
1. Chapter 4: Endocrine, Nutritional, and Metabolic Diseases (E00-E89)
a. Diabetes mellitus
Comprehensive coding guidelines for all types of diabetes, including type 1, type 2, gestational, and secondary diabetes. Includes instructions for coding complications, insulin use, and oral hypoglycemic medications.
b. Obesity
Guidelines for coding obesity, including morbid obesity and obesity-related conditions. Instructions for proper documentation and code assignment.
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Chapter 5
Mental, Behavioral and Neurodevelopmental Disorders
1. Chapter 5: Mental, Behavioral and Neurodevelopmental disorders (F01 – F99)
a. Pain disorders related to psychological factors
Assign code F45.41, Pain disorder exclusively related to psychological factors, for pain that is exclusively related to psychological disorders. Code F45.42, Pain disorder with related psychological factors, should be used with a code from category G89, Pain, not elsewhere classified, if there is documentation of a psychological component for a patient with acute or chronic pain.
b. Mental and behavioral disorders due to psychoactive substance use
Selection of codes for "in remission" for categories F10-F19, Mental and behavioral disorders due to psychoactive substance use requires the provider's clinical judgment. The appropriate codes for "in remission" are assigned only on the basis of provider documentation.
c. Factitious Disorder
Factitious disorder imposed on self or Munchausen's syndrome is a disorder in which a person falsely reports or causes his or her own physical or psychological signs or symptoms. For patients with documented factitious disorder on self or Munchausen's syndrome, assign the appropriate code from subcategory F68.1-, Factitious disorder imposed on self.
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Chapter 6
Diseases of the Nervous System
1. Chapter 6: Diseases of the Nervous System (G00-G99)
a. Dominant/nondominant side
Codes from category G81, Hemiplegia and hemiparesis, and subcategories, G83.1, Monoplegia of lower limb, G83.2, Monoplegia of upper limb, and G83.3, Monoplegia, unspecified, identify whether the dominant or nondominant side is affected. Should the affected side be documented, but not specified as dominant or nondominant, and the classification system does not indicate a default, code selection is as follows:
  • For ambidextrous patients, the default should be dominant.
  • If the left side is affected, the default is non-dominant.
  • If the right side is affected, the default is dominant.
b. Pain - Category G89
Category G89 contains codes for pain-related conditions. Detailed guidelines are provided for:
  • Acute and chronic pain
  • Neoplasm-related pain
  • Chronic pain syndrome
  • Central pain syndrome
  • Postprocedural pain
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Chapter 7
Diseases of the Eye and Adnexa
1. Chapter 7: Diseases of the Eye and Adnexa (H00-H59)
a. Glaucoma
Assign as many codes from category H40, Glaucoma, as needed to identify the type of glaucoma, the affected eye, and the glaucoma stage. When a patient has bilateral glaucoma and both eyes are documented as being the same type and stage, and there is a code for bilateral glaucoma, report only the code for the type of glaucoma, bilateral, with the seventh character for the stage. When a patient has bilateral glaucoma and each eye is documented as having a different type or stage, and the classification distinguishes laterality, assign the appropriate code for each eye rather than the code for bilateral glaucoma. When a patient has bilateral glaucoma and each eye is documented as having the same type, but different stage, and the classification does not distinguish laterality (i.e. subcategories H40.10, H40.11 and H40.20), assign a code for the type of glaucoma for each eye with the seventh character for the specific glaucoma stage documented for each eye. For glaucoma stage codes, the seventh character is based on the stage of the disease, not the stage of treatment.
b. Blindness
If "blindness" or "low vision" of both eyes is documented but the visual impairment category is not documented, assign code H54.3, Unqualified visual loss, both eyes. If "blindness" or "low vision" in one eye is documented but the visual impairment category is not documented, assign a code from H54.6-, Unqualified visual loss, one eye. If "blindness" or "visual loss" is documented without any information about whether one or both eyes are affected, assign code H54.7, Unspecified visual loss.
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Chapter 8
Diseases of the Ear and Mastoid Process
1. Chapter 8: Diseases of the Ear and Mastoid Process (H60-H95)
Reserved for future guideline expansion
This chapter covers diseases of the ear and mastoid process. Specific guidelines for this chapter are reserved for future expansion as coding practices evolve and new clinical documentation standards emerge.
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Chapter 9
Diseases of the Circulatory System
1. Chapter 9: Diseases of the Circulatory System (I00-I99)
a. Hypertension
The classification presumes a causal relationship between hypertension and heart involvement and between hypertension and kidney involvement, as the two conditions are linked by the term "with" in the Alphabetic Index. These conditions should be coded as related even in the absence of provider documentation explicitly linking them, unless the documentation clearly states the conditions are unrelated.
b. Atherosclerotic Coronary Artery Disease and Angina
ICD-10-CM has combination codes for atherosclerotic heart disease with angina pectoris. The subcategories for these codes are I25.11, Atherosclerotic heart disease of native coronary artery with angina pectoris and I25.7, Atherosclerosis of coronary artery bypass graft(s) and coronary artery of transplanted heart with angina pectoris.
c. Intraoperative and Postprocedural Cerebrovascular Accident
Medical record documentation should clearly specify the cause-and-effect relationship between the medical intervention and the cerebrovascular accident in order to assign a code for intraoperative or postprocedural cerebrovascular accident.
d. Sequelae of Cerebrovascular Disease
Category I69 is used to indicate conditions classifiable to categories I60-I67 as the causes of sequela (neurologic deficits), themselves classified elsewhere. These "late effects" include neurologic deficits that persist after initial onset of conditions classifiable to categories I60-I67.
e. Acute myocardial infarction (AMI)
The ICD-10-CM codes for type 1 acute myocardial infarction (AMI) identify the site, such as anterolateral wall or true posterior wall. Subcategories I21.0-I21.2 and code I21.3 are used for type 1 ST elevation myocardial infarction (STEMI). Code I21.4, Non-ST elevation (NSTEMI) myocardial infarction, is used for type 1 non-ST elevation myocardial infarction (NSTEMI) and nontransmural MIs.
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Chapter 10
Diseases of the Respiratory System
1. Chapter 10: Diseases of the Respiratory System (J00-J99), U07.0
a. Chronic Obstructive Pulmonary Disease [COPD] and Asthma
The codes in categories J44 and J45 distinguish between uncomplicated cases and those in acute exacerbation. An acute exacerbation is a worsening or a decompensation of a chronic condition. An acute exacerbation is not equivalent to an infection superimposed on a chronic condition, though an exacerbation may be triggered by an infection.
b. Acute Respiratory Failure
Acute respiratory failure may be assigned as a principal diagnosis when it is the condition established after study to be chiefly responsible for occasioning the admission to the hospital, and the selection is supported by the Alphabetic Index and Tabular List. However, chapter-specific coding guidelines (such as obstetrics, poisoning, HIV, newborn) that provide sequencing direction take precedence.
c. Influenza due to certain identified influenza viruses
Code only confirmed cases of influenza due to certain identified influenza viruses (category J09), and due to other identified influenza virus (category J10). This is an exception to the hospital inpatient guideline Section II, H. (Uncertain Diagnosis).
d. Ventilator associated Pneumonia
Assign code J95.851, Ventilator associated pneumonia, when the provider has documented ventilator associated pneumonia (VAP). An additional code to identify the organism (e.g., Pseudomonas aeruginosa, code B96.5) should also be assigned. Do not assign an additional code from categories J12-J18 to identify the type of pneumonia.
e. Vaping-related disorders
For patients presenting with condition(s) related to vaping, assign code U07.0, Vaping-related disorder, as the principal diagnosis. For lung injury due to vaping, assign only code U07.0. Assign additional codes for other manifestations, such as acute respiratory failure (subcategory J96.0-) or pneumonitis (code J68.0).
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Chapter 11
Diseases of the Digestive System
1. Chapter 11: Diseases of the Digestive System (K00-K95)
Reserved for future guideline expansion
This chapter covers diseases of the digestive system, including conditions affecting the mouth, esophagus, stomach, intestines, liver, gallbladder, and pancreas. Specific guidelines for this chapter are reserved for future expansion.
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Chapter 12
Diseases of the Skin and Subcutaneous Tissue
1. Chapter 12: Diseases of the Skin and Subcutaneous Tissue (L00-L99)
a. Pressure ulcer stage codes
Two codes are needed to completely describe a pressure ulcer: a code from category L89, Pressure ulcer, to identify the site of the pressure ulcer as well as the stage of the ulcer. The codes in category L89, Pressure ulcer, identify the site and stage of the pressure ulcer.
Stage 1
Pre-ulcer skin changes limited to persistent focal edema
Stage 2
Abrasion, blister, partial thickness skin loss involving epidermis and/or dermis
Stage 3
Full thickness skin loss involving damage or necrosis of subcutaneous tissue
Stage 4
Necrosis of soft tissues through to underlying muscle, tendon, or bone
b. Non-Pressure Chronic Ulcers
Codes from category L97, Non-pressure chronic ulcer of lower limb, not elsewhere classified, and category L98, Other disorders of skin and subcutaneous tissue, not elsewhere classified, are combination codes that identify the site of the non-pressure chronic ulcer as well as the severity of the ulcer. The codes in these categories identify the site and severity of the non-pressure chronic ulcer.
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Chapter 13
Diseases of the Musculoskeletal System
1. Chapter 13: Diseases of the Musculoskeletal System and Connective Tissue (M00-M99)
a. Site and laterality
Most of the codes within Chapter 13 have site and laterality designations. The site represents the bone, joint or the muscle involved. For some conditions where more than one bone, joint or muscle is usually involved, such as osteoarthritis, there is a "multiple sites" code available. For categories where no multiple site code is provided and more than one bone, joint or muscle is involved, multiple codes should be used to indicate the different sites involved.
b. Acute traumatic versus chronic or recurrent musculoskeletal conditions
Many musculoskeletal conditions are a result of previous injury or trauma to a site, or are recurrent conditions. Bone, joint or muscle conditions that are the result of a healed injury are usually found in chapter 13. Recurrent bone, joint or muscle conditions are also usually found in chapter 13. Any current, acute injury should be coded to the appropriate injury code from chapter 19. Chronic or recurrent conditions should generally be coded with a code from chapter 13. If it is difficult to determine from the documentation in the record which code is best to describe a condition, query the provider.
c. Coding of Pathologic Fractures
7th character A is for use as long as the patient is receiving active treatment for the fracture. While the patient may be seen by a new or different provider over the course of treatment for a pathological fracture, assignment of the 7th character is based on whether the patient is undergoing active treatment and not whether the provider is seeing the patient for the first time.
d. Osteoporosis
Osteoporosis is a systemic condition, meaning that all bones of the musculoskeletal system are affected. Therefore, site is not a component of the codes under category M81, Osteoporosis without current pathological fracture. The site codes under category M80, Osteoporosis with current pathological fracture, identify the site of the fracture, not the osteoporosis.
e. Multisystem Inflammatory Syndrome
Codes M35.81-, Multisystem inflammatory syndrome, should be assigned for conditions documented as multisystem inflammatory syndrome and for conditions documented as pediatric inflammatory multisystem syndrome (PIMS). Assign code M35.81- when multisystem inflammatory syndrome is described as being due to COVID-19. If the condition is documented as being associated with a different infectious disease, assign the appropriate code for the infectious disease. If the infectious disease is not specified, assign code B99.8, Other infectious disease.
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Chapter 14
Diseases of Genitourinary System
1. Chapter 14: Diseases of Genitourinary System (N00-N99)
a. Chronic kidney disease
The ICD-10-CM classifies CKD based on severity. The severity of CKD is designated by stages 1-5. Stage 2, code N18.2, equates to mild CKD; stage 3, codes N18.30-N18.32, equate to moderate CKD; and stage 4, code N18.4, equates to severe CKD. Code N18.6, End stage renal disease (ESRD), is assigned when the provider has documented end-stage-renal disease (ESRD).
If both a stage of CKD and ESRD are documented, assign code N18.6 only.
Patients with CKD may also suffer from other serious conditions, most commonly diabetes mellitus and hypertension. The sequencing of the CKD code in relationship to codes for other contributing conditions is based on the conventions in the Tabular List.
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Chapter 15
Pregnancy, Childbirth, and the Puerperium
1. Chapter 15: Pregnancy, Childbirth, and the Puerperium (O00-O9A)
a. General Rules for Obstetric Cases
Codes from chapter 15 and sequencing priority: Obstetric cases require codes from chapter 15, codes in the range O00-O9A, Pregnancy, Childbirth, and the Puerperium. Chapter 15 codes have sequencing priority over codes from other chapters. Additional codes from other chapters may be used in conjunction with chapter 15 codes to further specify conditions. Should the provider document that the pregnancy is incidental to the encounter, then code Z33.1, Pregnant state, incidental, should be used in place of any chapter 15 codes. It is the provider's responsibility to state that the condition being treated is not affecting the pregnancy.
Chapter 15 codes used only on the maternal record: Chapter 15 codes are to be used only on the maternal record, never on the record of the newborn.
Final character for trimester: The majority of codes in Chapter 15 have a final character indicating the trimester of pregnancy. The timeframes for the trimesters are indicated at the beginning of the chapter. If trimester is not a component of a code it is because the condition always occurs in a specific trimester, or the concept of trimester of pregnancy is not applicable. Certain codes have characters for only certain trimesters because the condition does not occur in all trimesters, but it may occur in more than just one.
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Chapter 15 Guidelines Continued
b. Selection of OB Principal or First-listed Diagnosis
c. Pre-existing conditions versus conditions due to the pregnancy
d. Pre-existing hypertension in pregnancy
e. Fetal Conditions Affecting the Management of the Mother
f. HIV Infection in Pregnancy, Childbirth and the Puerperium
During pregnancy, childbirth or the puerperium, a patient admitted because of an HIV-related illness should receive a principal diagnosis from subcategory O98.7-, Human immunodeficiency [HIV] disease complicating pregnancy, childbirth and the puerperium, followed by the code(s) for the HIV-related illness(es).
g. Diabetes mellitus in pregnancy
Diabetes mellitus is a significant complicating factor in pregnancy. Pregnant women who are diabetic should be assigned a code from category O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium, first, followed by the appropriate diabetes code(s) (E08-E13) from Chapter 4.
h. Long term use of insulin and oral hypoglycemics
i. Gestational (pregnancy induced) diabetes
j. Sepsis and septic shock complicating abortion, pregnancy, childbirth and the puerperium
k. Puerperal sepsis
Code O85, Puerperal sepsis, should be assigned with a secondary code to identify the causal organism (e.g., for a bacterial infection, assign a code from category B95-B96, Bacterial infections in conditions classified elsewhere). A code from category A40, Streptococcal sepsis, or A41, Other sepsis, should not be used for puerperal sepsis. If applicable, use additional codes to identify severe sepsis (R65.2-) and any associated acute organ dysfunction.
l. Alcohol, tobacco and drug use during pregnancy, childbirth and the puerperium
Codes under subcategory O99.31, Alcohol use complicating pregnancy, childbirth, and the puerperium, should be assigned for any pregnancy case when a mother uses alcohol during the pregnancy or postpartum. A secondary code from category F10, Alcohol related disorders, should also be assigned to identify manifestations of the alcohol use.
m. Poisoning, toxic effects, adverse effects and underdosing in a pregnant patient
A code from subcategory O9A.2, Injury, poisoning and certain other consequences of external causes complicating pregnancy, childbirth, and the puerperium, should be sequenced first, followed by the appropriate injury, poisoning, toxic effect, adverse effect or underdosing code, and then the additional code(s) that specifies the condition caused by the poisoning, toxic effect, adverse effect or underdosing.
n. Normal Delivery, Code O80
Code O80 should be assigned when a woman is admitted for a full-term normal delivery and delivers a single, healthy infant without any complications antepartum, during the delivery, or postpartum during the delivery episode. Code O80 is always a principal diagnosis. It is not to be used if any other code from chapter 15 is needed to describe a current complication of the antenatal, delivery, or perinatal period. Additional codes from other chapters may be used with code O80 if they are not related to or are in any way complicating the pregnancy.
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Chapter 15 Guidelines Final Topics
o. The Peripartum and Postpartum Periods
The postpartum period begins immediately after delivery and continues for six weeks following delivery. The peripartum period is defined as the last month of pregnancy to five months postpartum. A postpartum complication is any complication occurring within the six-week period.
p. Code O94, Sequelae of complication of pregnancy, childbirth, and the puerperium
Code O94, Sequelae of complication of pregnancy, childbirth, and the puerperium, is for use in those cases when an initial complication of a pregnancy develops a sequelae requiring care or treatment at a future date.
q. Termination of Pregnancy and Spontaneous abortions
Codes from Chapter 15 may be used for encounters for termination of pregnancy and spontaneous abortions. Assign the appropriate code from category O07, Failed attempted termination of pregnancy, or category O08, Complications following ectopic and molar pregnancy.
r. Abuse in a pregnant patient
For suspected or confirmed cases of abuse of a pregnant patient, a code(s) from subcategories O9A.3, Physical abuse complicating pregnancy, childbirth, and the puerperium, O9A.4, Sexual abuse complicating pregnancy, childbirth, and the puerperium, and O9A.5, Psychological abuse complicating pregnancy, childbirth, and the puerperium, should be sequenced first, followed by the appropriate codes (if applicable) to identify any associated current injury due to physical abuse, sexual abuse, and the perpetrator of abuse.
s. COVID-19 infection in pregnancy, childbirth, and the puerperium
During pregnancy, childbirth or the puerperium, when COVID-19 is the reason for admission/encounter, code O98.5-, Other viral diseases complicating pregnancy, childbirth and the puerperium, should be sequenced as the principal/first-listed diagnosis, and code U07.1, COVID-19, and the appropriate codes for associated manifestation(s) should be assigned as additional diagnoses. Codes from Chapter 15 always take sequencing priority.
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Chapter 16 & 17
Perinatal and Congenital Conditions
1. Chapter 16: Certain Conditions Originating in the Perinatal Period (P00-P96)
a. General Perinatal Rules
For coding and reporting purposes, the perinatal period is defined as before birth through the 28th day following birth. The following guidelines are provided for reporting purposes.
Key Topics:
  • b. Observation and Evaluation of Newborns for Suspected Conditions not Found
  • c. Coding Additional Perinatal Diagnoses
  • d. Prematurity and Fetal Growth Retardation
  • e. Low birth weight and immaturity status
  • f. Bacterial Sepsis of Newborn
  • g. Stillbirth
  • h. COVID-19 Infection in Newborn
1. Chapter 17: Congenital malformations, deformations, and chromosomal abnormalities (Q00-QA1)
Assign an appropriate code(s) from categories Q00-QA1, Congenital malformations, deformations, and chromosomal abnormalities when a malformation/deformation or chromosomal abnormality is documented. A malformation/deformation or chromosomal abnormality may be the principal/first-listed diagnosis on a record or a secondary diagnosis.
When a malformation/deformation or chromosomal abnormality does not have a unique code assignment, assign additional code(s) for any manifestations that may be present. When the code assignment specifically identifies the malformation/deformation or chromosomal abnormality, manifestations that are an inherent component of the anomaly should not be coded separately. Additional codes should be assigned for manifestations that are not an inherent component.
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Final Chapters
Remaining Chapter Guidelines
Chapter 18: Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
Includes guidelines for use of symptom codes, combination codes, repeated falls, coma, functional quadriplegia, SIRS due to non-infectious process, death NOS, and NIHSS Stroke Scale.
Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)
Comprehensive guidelines for application of 7th characters, coding of injuries, traumatic fractures, burns and corrosions, adverse effects, poisoning, underdosing and toxic effects, adult and child abuse, and complications of care.
Chapter 20: External Causes of Morbidity (V00-Y99)
Guidelines for general external cause coding, place of occurrence, activity codes, multiple external cause coding, child and adult abuse, unknown or undetermined intent, sequelae of external causes, terrorism, and external cause status.
Chapter 21: Factors influencing health status and contact with health services (Z00-Z99)
Use of Z codes in any healthcare setting, Z codes indicating reason for encounter or providing additional patient information, and comprehensive categories of Z codes.
Section II, III, and IV
Section II
Selection of Principal Diagnosis for inpatient settings
Section III
Reporting Additional Diagnoses in non-outpatient settings
Section IV
Diagnostic Coding and Reporting Guidelines for Outpatient Services
Appendix I: Present on Admission Reporting Guidelines
Additional guidelines for reporting conditions present at the time of inpatient admission.
Thank you for reviewing the ICD-10-CM Official Guidelines for Coding and Reporting FY 2026
Your comprehensive guide to accurate medical coding and reporting.
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