ICD-10-CM Changes

Memo

Date: October 17, 2025

To: All Providers, APPs, Clinical Staff, Scheduling, Billing & Coding

From: Medical Director & Coding Director

Subject: Subject: ICD-10-CM Changes Effective October 1, 2025

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Bottom Line

• G89 usage: Continue to report G89 (Pain, NEC) in addition to the site/etiology code when the encounter is for pain control/management (acute, chronic, acute on chronic, or post-op). Do not add G89 if the visit is only evaluating a symptom without a pain-management focus.

• R10 specificity: The R10 chapter expanded with new options, including flank and more granular pelvic/perineal pain. Many codes now require a 5th character for side (right/left/bilateral/unspecified). Use the most specific laterality available.

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Key Timeline & Documents

The CDC and CMS released the FY 2026 ICD-10-CM diagnosis code set for use from October 1, 2025, to September 30, 2026.

FY 2025 updates (effective October 1, 2024) remain valid until end-September 2025

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Update Volume & Scope

The FY 2026 ICD-10-CM update consists of the following key changes:

New codes: 487

Revised codes: 38

Deleted codes: 28

These changes include expansions across many chapters, modified instructions (Excludes 1/2, Code First, Use Additional), and granularity improvements.

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Specificity - Pain Management Codes

• Category G89 (Pain, not elsewhere classified)

  • May be used as a principal or first-listed diagnosis when pain control or pain management is the reason for the encounter (e.g., neurostimulator insertion, pain injection).

  • When site-specific pain is also coded (e.g., cervicalgia, dorsalgia):

    • If pain control is the focus → code G89 first, then the site-specific code.

    • If encounter is not for pain management, and no definitive diagnosis is established → code site-specific pain first, then G89

• Postoperative Pain

  • Routine expected postoperative pain → not coded.

  • Postoperative pain is not associated with a complication → assign G89 postoperative pain codes.

  • Postoperative pain due to complication → code as injury/complication (Chapter 19); add G89 as secondary if appropriate.

  • If documentation only states “postoperative pain” without further detail → default to acute postoperative pain (G89.18).

• Core Pain Coding Practice Updates

  • Use specific G89 codes where possible:

    • G89.21 – Chronic pain due to trauma

    • G89.28 – Other chronic postprocedural pain

    • G89.29 – Other chronic pain NEC

    • G89.4 – Chronic pain syndrome

    • G89.3 – Neoplasm related pain

  • Pair G89 codes with site-specific codes when applicable (e.g., limb or neurological pain).

  • Document psychological/behavioral factors related to chronic pain using F-codes (e.g., anxiety, depression).

  • Differentiate acute vs chronic pain: ≥3 months = chronic.

• New & Revised Pain-Related Codes (FY 2026)

  • Expanded “R” ‑series symptom codes: 12 new codes for abdominal, pelvic, and perineal pain, breaking down R10.2 (pelvic/perineal pain) into six laterality-specific options.

    • Pelvic / Perineal Pain

      • R10.20 – Unspecified side

      • R10.21 – Right side

      • R10.22 – Left side

      • R10.23 – Bilateral

      • R10.24 – Suprapubic pain

    • Lower Abdominal Pain

      • R10.30 – Unspecified side

      • R10.31 – Right side

      • R10.32 – Left side

      • R10.33 – Bilateral

    • Abdominal Pain

      • R10.85 – Multiple site

      • Flank Tenderness

      • R10.8A1 – Right side

      • R10.8A2 – Left side

      • R10.8A3 – Suprapubic

      • R10.8A9 – Unspecified side

    • Flank Pain

      • R10.A0 – Unspecified side

      • R10.A1 – Right side

      • R10.A2 – Left side

      • R10.A3 – Bilateral

• Deleted Codes & Mapping

  • Now maps to R10.20–R10.23 depending on documentation.

• Key Notes

  • Use new laterality-specific codes instead of generic R10.2.

  • Select unspecified codes (R10.20, R10.30, R10.A0) only when documentation does not identify side or sex.

  • Encourage providers to document location + laterality to capture the highest specificity (5th/6th digits).

— End of Memo —

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