If you code inpatient procedures, mark your calendar. The Centers for Medicare & Medicaid Services (CMS) released the new ICD-10-PCS codes for fiscal year 2027 in June, and they go live on October 1, 2026. The guideline changes this round are light, but the table-level updates are anything but minor — several brand-name devices and technologies are getting their own dedicated codes for the first time.
Most of the new entries add qualifier values for generic devices. A handful, though, call out specific branded products by name, and we’ll flag those as we go.
This piece covers what’s changing in four sections of ICD-10-PCS: Medical and Surgical, Administration, Extracorporeal or Systemic Assistance and Performance, and Imaging. A follow-up article will dig into the New Technology section separately.
For the full technical rationale behind each change, CMS publishes the minutes from the Spring 2026 ICD-10 Coordination and Maintenance Committee Meeting — worth a read if you want the committee’s own reasoning.
Medical and Surgical Section Changes
Table 028 — Heart and Great Vessels, Division
A new row now covers the Aortic valve (F) and Mitral valve (G), each pairable with two qualifiers: Native leaflet (0) or Prosthetic leaflet (1).
This addition supports coding for LAMPOON (Laceration of the Anterior Mitral Leaflet to Prevent Outflow Obstruction) — a minimally invasive technique in which the anterior mitral leaflet is intentionally sliced to prevent a potentially fatal outflow blockage. The FDA cleared this procedure under an Investigational Device Exemption (IDE), the pathway that allows unapproved or new-use devices to be studied legally in humans.
Table 0RG (Upper Joints, Fusion) and Table 0SG (Lower Joints, Fusion)
Both tables gain a new device value: Interbody fusion device, custom-made anatomically and virtually designed (E).
- Upper joints (R): used with body part value Thoracolumbar vertebral joint (A)
- Lower joints (S): used with body part values Lumbar vertebral joints (0, 1) and Lumbosacral joint (3)
This device is a patient-specific, 3D-printed spinal implant generated from AI modeling and CT scan data, engineered to match a patient’s exact anatomy. The intent is better spinal alignment and a lower risk of complications like implant subsidence or migration into nearby vertebrae. It, too, carries FDA approval under an IDE.
Previously, these procedures were billed through New Technology (X) codes tied to body part values Thoracolumbar vertebral joint (A), Lumbar vertebral joints (B, C), or Lumbosacral joint (D), using device value Interbody fusion device, custom-made anatomically designed (R). Those New Technology codes have now been retired and folded into the Medical and Surgical section — a sign that the procedure has matured into standard clinical practice.
One exception: the New Technology section still retains a code for the anatomically designed (non-virtual) version of this device for cervical procedures — body part values Cervical vertebral joints (1, 2) and Cervicothoracic vertebral joint (4).
Table 0W9 — Anatomical Regions, General, Drainage
Body part values Pleural cavity (9, B) and Mediastinum (C) now sit in new rows carrying a new qualifier: Active mechanical clearance (3).
This change supports coding for the PleuraFlow® Active Clearance Technology® (ACT®) System, an FDA-approved device used during and after cardiothoracic surgery to actively clear clots that can obstruct chest tubes.
Administration Section Changes
Table 302 — Administration, Circulatory, Transfusion
Body part values Peripheral vein (3) and Central vein (4) now have a new row with qualifier value Immune globulin, high-dose (5).
High-dose IVIG (hdIVIg) is an FDA-approved intravenous antibody therapy pooled from thousands of donors. Unlike standard-dose immune globulin, which addresses immunodeficiencies, the high-dose version functions as an immunosuppressant — used to calm severe autoimmune flares, neutralize harmful antibodies, and bring down inflammation quickly.
These infusions used to be billed under temporary New Technology codes (table XW1, values Anatomical regions (W), Transfusion (1), High-dose intravenous immune globulin hyperimmune globulin (D)). Those codes are gone now, not because the therapy changed, but because its New Technology Add-on Payment (NTAP) expired. NTAP is the mechanism CMS uses to give hospitals extra, temporary reimbursement — up to 65% of the added technology cost — to encourage early adoption of expensive new treatments.
Table 3E0 — Administration, Physiological Systems and Anatomical Regions, Introduction
Body part values Skin and mucous membranes (0) and Subcutaneous tissue (1) get a new qualifier: Other Enzymatic/chemical agent (F).
This entry exists to code Anacaulase-bcdb, marketed as NexoBrid — a topical botanical drug the FDA approved for debriding eschar (dead tissue) from severe deep partial- and full-thickness thermal burns.
Like the immune globulin update above, this drug moved out of the New Technology section (previously table XW0, values Anatomical regions (W), Introduction (0), Anacaulase-bcdb (2)) because its temporary add-on payment period ended, shifting it into the permanent Administration tables.
Extracorporeal or Systemic Assistance and Performance Section Changes
Table 5A0 — Physiological Systems, Assistance
A new row appears for body system Circulatory (5), duration Continuous (2), function value Decompression (7), and qualifier Impeller pump (D).
This supports coding for the WhiteSwell eLym™ System, designed for adult patients with acute decompensated heart failure and fluid overload who haven’t responded to diuretics. Placed percutaneously into the innominate vein under ultrasound and fluoroscopic guidance, the device creates a lower-pressure zone that pulls excess lymph fluid out of the tissues and into the bloodstream. It can stay in place for up to 60 hours of continuous treatment.
Coding this procedure takes two codes:
- Device insertion — table X2H, body part Innominate vein, left (4), approach Percutaneous (3), device/substance/technology value Temporary intraluminal device, venous angle decompression using impeller pump (M)
- Decompression itself — table 5A0, body system Circulatory system (5), duration Continuous (2), function Decompression (7), qualifier Impeller pump (D)
The WhiteSwell eLym System holds FDA Breakthrough Device designation.
Imaging Section Changes
Table B85 — Imaging, Eye, Other Imaging (New Table)
This brand-new table covers body part values Choroid (A, B) and Retinal vessel (G, H), contrast value Fluorescing agent (2), and qualifier None (Z).
It’s built for fluorescein angiography, a diagnostic eye exam that maps blood flow through the retina and choroid — the pigmented vascular layer sitting between the retina and the sclera. Clinicians inject a fluorescent dye (brands include FLUORESCITE® and AK-FLUOR®) and capture rapid sequential images with a specialized ophthalmic camera, such as the Sentinel Camera (AI Optics) or the CLARUS 700 (Zeiss Meditec). Because the technique relies on light stimulation rather than ionizing radiation, it’s a radiation-free way to evaluate retinal and choroidal circulation.
Key Takeaways for FY 2027
- Effective date: October 1, 2026
- Biggest theme: Several devices are graduating from temporary New Technology codes into permanent Medical and Surgical, Administration, and Extracorporeal Assistance codes — usually because their NTAP funding expired or the procedure became standard of care.
- Watch for: The custom 3D-printed spinal fusion device, high-dose IVIG, NexoBrid for burn debridement, the WhiteSwell eLym decompression system, and the new fluorescein angiography table.
- Coming next: Part two of this series will cover what’s new in the New Technology section for FY 2027.
Coders and CDI teams should update their encoders and internal cheat sheets well before the October 1 effective date, and cross-check any procedures currently billed under soon-to-be-deleted New Technology codes.
