The medical coding landscape isn’t static — it breathes, grows, and adapts each year to reflect new science, new technology, and new ways we deliver care. The 2025–2026 updates to both ICD (International Classification of Diseases, Clinical Modification and Procedure Coding System) and CPT (Current Procedural Terminology) were particularly notable: large volumes of new codes, targeted deletions and revisions, and clearer guidance around emerging areas like telehealth, remote monitoring, and artificial intelligence (AI)-assisted services. This article walks through the most important changes, explains their practical effect on documentation and billing, and offers a human-centered view of how clinicians and coding teams can prepare and adapt.
Big-picture numbers: more codes, more nuance
The year-over-year codebook churn is substantial this cycle. The CPT 2025 update added hundreds of changes: the AMA reported several hundred total edits across the 2025 and 2026 releases, including large numbers of new codes and deletions as the code set expands into specialty testing and digital/virtual care domains. For the 2026 CPT code set, the AMA documented 418 total changes — 288 new codes, 84 deletions, and 46 revisions — showing the continued pace of evolution. These new CPT entries reflect growth especially in proprietary laboratory analyses and Category III codes for emerging services. American Medical Association+1
On the diagnosis side, ICD-10-CM updates for FY 2026 (effective October 1, 2025) brought hundreds of changes as well — hundreds of new codes, dozens of revisions, and a smaller set of deletions. The FY2026 ICD-10-CM guidelines PDF from CMS and NCHS details narrative edits and revisions intended to clarify sequencing and reporting conventions. These updates are not just “more codes”; they reshape how conditions and encounters are described at a clinical level. cms.gov+1
Thematic shifts: telehealth, remote monitoring, AI, and genetics
Three themes stood out across CPT and ICD updates: formalization of virtual care, expansion of codes for physiologic and remote monitoring, and recognition of AI-assisted workflows and advanced laboratory/genetic tests.
Telehealth: The 2025 CPT release introduced dedicated telemedicine E/M-style codes and reorganized telephone and audio-only services, intending to bring coding clarity and parity to remote evaluations. This makes it easier for coders to select codes that explicitly represent remote visits rather than using workarounds or legacy telephone codes. For many clinicians this should simplify billing and reduce denials tied to code selection errors. SMFM
Remote monitoring and virtual care: CPT updates over 2025–2026 expanded remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) code sets and added guidance around who can bill and what documentation is essential. These changes reflect the shift from episodic to continuous-care models where data streams from wearables, implanted sensors, or home devices feed into clinical decision-making.
AI and augmented intelligence: Perhaps the most forward-looking changes were the CPT entries introduced to describe AI-assisted interpretation, triage, or clinical decision support. While many of these codes are initially Category III (tracking emerging technologies), their presence signals that payers and regulators intend to monitor clinical adoption and outcomes before broader Category I assignment and reimbursement. Several industry write-ups and coding resources flagged new AI-related codes and guidance as a major theme in the 2025–2026 cycle. Practolytics+1
Genomics and proprietary laboratory tests: A large proportion of new CPT codes in 2025 and 2026 were for novel laboratory analyses — particularly genetic and molecular tests — often proprietary to specific vendors. This has downstream implications for billing (e.g., prior auth complexity), documentation (clear test names and indications), and revenue cycle teams (ensuring correct mapping to payers and patient financial counseling).
Practical impacts on documentation and billing
With a flood of new codes comes a simple truth: accuracy now depends more than ever on high-quality documentation. Here’s what practices should emphasize.
- Be specific, be granular. ICD-10-CM has long favored specificity, and the 2025–2026 updates only reinforce that preference. Coders need precise problem lists, laterality, staging or severity when relevant, and clear links between symptoms and diagnoses. The official ICD-10-CM guidelines for FY2025 and FY2026 contain important sequencing and reporting rules coders must follow. cms.gov+1
- Document digital/remote encounters clearly. For telehealth and RPM/RTM, documentation must show modality (audio, video, asynchronous messaging), consent where required, time spent (when time-based codes apply), device data summaries, and clinical interpretation or action taken. Ambiguity invites denials.
- Name tests exactly. Proprietary lab codes and molecular tests often require the exact manufacturer or assay name on documentation and claims to avoid mismatches. Revenue cycle teams should maintain a current crosswalk between lab order names and CPT codes.
- Track AI usage. When AI tools contribute materially to diagnosis or interpretation, document what the tool did, how results informed clinician decision-making, and clinician review or overrides. Even if reimbursement for AI is limited initially, documentation fosters transparency and compliance.
Coding teams: workflow changes and triage priorities
Given the volume of changes, coding teams must adjust processes:
- Prioritize high-impact areas. Focus training on specialties and services that saw the most change: genetics/proprietary labs, telehealth, remote monitoring, and any new Category I additions (e.g., newly recognized procedures such as certain robotic therapies). AMA and specialty societies published guides summarizing the large CPT edits for 2025 and 2026 — use those as an initial roadmap. American Medical Association+1
- Update code mapping tools and EHR picklists. Even small name variations can cause claims to land on the wrong code. Coordinate with EHR teams to refresh picklists and decision support rules before the effective dates (October 1 for ICD fiscal updates; January 1 for many CPT calendar-year updates).
- Bolster pre-authorization and payer relations. New lab tests and novel procedures may require prior authorization or have limited coverage. Early payer outreach and standardized prior-auth packets reduce denials and surprise billing for patients.
- Train clinicians with short, practical sessions. Clinicians don’t need to memorize code changes, but they do need to know what details to capture. Bite-sized training (10–20 minute sessions) that uses examples from the practice’s most common visits is more effective than theory-heavy lectures.
Compliance, auditing, and risk mitigation
New codes and new technologies can invite auditing scrutiny. Common audit triggers include inconsistent documentation relative to billed code, use of emergent or Category III codes without clear clinical rationale, and billing for device-generated data without evidence of clinician involvement.
- Keep a “change log” for new technology. When a practice begins using a new AI tool, telehealth workflow, or proprietary lab, document the rollout timeline, clinical use cases, consent templates, and internal policies. That log is a powerful defense if auditors question why a new code was used.
- Run focused internal audits early. After implementing new code sets, run small, targeted audits of high-risk areas (e.g., top 25 claims in dollar value or most common newly coded procedures) and provide immediate feedback loops.
- Stay current with payer bulletins. Payers sometimes issue local coverage determinations (LCDs) or policy updates around new CPT codes faster than national guidelines. Revenue teams should subscribe to payer portals and update their denials logic accordingly. CMS also publishes lists (e.g., annual HCPCS/CPT updates) that practices should monitor. cms.gov
What smaller practices and solo clinicians should do (practical checklist)
- Update EHR and billing software now — coordinate with vendors to ensure the latest code tables are installed.
- Run a training hour — focus on documentation changes tied to telehealth, RPM/RTM, and genetic testing.
- Check lab interfaces — confirm that lab names and test IDs map correctly to new CPT codes.
- Review top 50 diagnoses and procedures — ensure any new ICD or CPT options are correctly applied and that staff know when to use them.
- Set up a payer watch — identify the top 3 payers and subscribe to their provider updates for 2025–2026 policy shifts.
Looking forward: trends and what to expect next
The 2025–2026 updates are best seen as incremental steps in broader trends: medicine is digitalizing, diagnostics are becoming more molecular and vendor-specific, and automation/AI is moving from novelty into clinical workflows. Expect the following trajectory:
- Greater granularity in lab and molecular coding as precision medicine expands, which will increase the administrative complexity of ordering and billing such tests.
- Progressive formalization of AI and algorithm-driven services — what starts as Category III tracking today is likely to evolve into Category I coverage if clinical outcomes and payer economics align.
- Increased payer-specific rules around remote monitoring as CMS and commercial payers refine what counts as billable monitoring versus patient-generated data with no clinician involvement.
Final thoughts: humanizing coding change
It’s tempting to view code updates as dry administrative minutiae, but the reality is more human: these updates reflect new treatments that can reduce suffering, technological tools that can improve diagnostic speed, and reimbursement rules that decide whether a practice can sustain offering a service. Good coding and documentation are the connective tissue between innovation and patient access. When clinicians and coders collaborate — translating nuance from the exam room into the code fields — patients benefit through accurate billing, fewer denials, and more timely access to appropriate care.
If you want, I can:
- produce a short, practice-specific checklist tailored to your specialty (e.g., primary care, cardiology, oncology), or
- draft a one-page clinician handout summarizing the exact documentation language to capture for telehealth, AI-reviewed results, and remote monitoring visits.
Tell me which specialty or focus you want and I’ll create it right away. (No waiting — I’ll generate it here and now.)
Sources (key references)
- American Medical Association — CPT® 2025 and CPT® 2026 code set release notes and summaries. American Medical Association+1
- Centers for Medicare & Medicaid Services (CMS) — ICD-10-CM Official Guidelines for FY2025 and FY2026 (updated October 1, 2024 and October 1, 2025). cms.gov+1
- Industry summaries and coding resources noting major themes (telehealth, AI, RPM/RTM) in CPT 2025–2026 updates. Practolytics+1
Very Informative