The first step is to identify a need for the new code or a revision of a current code.
Anyone can petition for a new ICD-10-CM or ICD-10-PCS code. ICD-10-CM is administered by the Centers of Disease Control and Prevention (CDC) and ICD-10-PCS is administered by the Centers for Medicare and Medicaid Services (CMS). Each of the websites has posted the process for requesting a new code.
The first step in the process is to identify a need for the new code or a revision of a current code. This step can be determined by a private citizen, a company, healthcare organization, or governmental agency. The CDC and CMS proposals are maintained on their respective websites and these documents are wonderful guides in completing the request for a new code. This step ends with the completion of the application for a new code which can be found on the CDC or CMS websites.
The application for a new code requires a description of the new code and why the code is needed. The applicant will need to describe the reasoning for the new code and provide some alternative code options. It is advisable to have clinical support for the new code. The clinical support will include a description of the disease, its treatment, and how the new code will be utilized. Supporting clinical literature should also be submitted with the application. The application for the new code is forwarded to the Coordination and Maintenance Committee. The Coordination and Maintenance Committee will assign a classification expert to assist the application through the process. The application is submitted at least three months prior to the Coordination and Maintenance Committee meeting.
The application is reviewed at Coordination and Maintenance Committee. Any questions will be sent to the applicant. There are pre-meetings to determine if the application is accepted or rejected. As stated before CDC will review requests for new diagnosis codes and CMS will review the applications for new procedure codes. Coordination and Maintenance Committee will determine if the application has merit and inform the applicant of acceptance or rejection. The next step is to present at Coordination and Maintenance Committee meeting in March or September.
The presentation at Coordination and Maintenance Committee includes a clinical presentation and potential code options. Usually, the clinical presentation is completed by a physician. The code options are reviewed by the CDC or CMS. In the recent years, the meetings have been virtual, but in the past attendees could be present in person. During the presentation, attendees can ask questions about the code or about the clinical information. This time is ideal to understand the “spirit” of the code. Coders can learn about why a code has been requested and the reasoning for collecting the data.
The Coordination and Maintenance Committee meeting is not the end of the code application. After the presentation at the public meeting, the public can send comments regarding the new code requests. The Coordination and Maintenance Committee may request additional information from the applicant to respond to these questions.
As an applicant, when you see the published proposed codes then you know if your application has been successful. There is a period after the published proposed code for additional comments to be submitted. The final codes are published in June. If the application is rejected, the application can be revised and submitted for consideration later. The process can take six months or longer until the codes are finalized.
The coming year will be a little different as Final Rule for Inpatient Prospective Payment System (IPPS) FY22 published the acceptance of an April 1st code release beginning with April 1, 2022. The process for the publication of final codes for implementation April 1st has not yet been revealed.
The Coordination and Maintenance Committee Meeting on Sept. 14 and 15 should provide more detailed information regarding this process.
Programming Note: Listen to Laurie Johnson’s Coding Report on Talk Ten Tuesdays every Tuesday, 10 Eastern.
Resources: https://www.cdc.gov/nchs/icd/icd10_maintenance.htm#Submission
https://www.cms.gov/Medicare/Coding/ICD10/newrevisedcodes
In a recent article, I described a documentation environment governed by two distinct and often competing controlling systems. The first is the regulatory framework established
Coders may very well feel that they have no impact on hospitals under H.R.1, the so-called One Big Beautiful Bill Act (OBBBA). Just the opposite
Please log in to your account to comment on this article.
Gain clarity and confidence in OB‑GYN coding with this expert‑led webcast featuring Stacey Shillito, CDIP, CPMA, CCS, CCS‑P, CPEDC, COPC. You’ll learn how to apply global maternity package rules accurately, select the right CPT codes for procedures and visits, and identify documentation gaps that lead to denials. With practical guidance and real examples, this session helps you strengthen compliance, reduce audit risk, and ensure accurate reimbursement for women’s health services.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s third quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
BLOOM INTO SAVINGS! Get 25% OFF during our spring sale through March 27. Use code SPRING26 at checkout to claim this offer.
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
