FY 2026 IPPS Preview/Guideline Review – Part III

Summer is here! I hope you are enjoying some sunshine and relaxation. We are only a few short weeks away from the Inpatient Prospective Payment System (IPPS) Final Rule for the 2026 fiscal year, so we are continuing with our preview.  

The first code we are going to take a look at is B88.01, Infestation by Demodex mites. Your first question might be…what are Demodex mites? It was certainly my first question. According to WebMD, they are tiny, eight-legged parasites. These mites generally live in hair follicles and oil glands on the face, neck, or chest, most commonly around the eyelids and eyelashes. WebMD does try to reassure us by noting they are usually harmless, unless you get too many of them, causing an infection that irritates your skin. It further notes the Demodex mites are very common, and can’t be seen without a microscope. Even face-scrubbing doesn’t cause them to fall off, but you won’t even know they are there unless your skin starts to act up. Small numbers of Demodex mites are even thought to be beneficial, helping to remove dead skin cells and excess oil. I did not include a picture here, but if you want to do a little more research, you will find out there are two different types of Demodex mites that live on humans. 

The next set of proposed codes is for Usher syndrome. According to Cleveland Clinic, Usher syndrome is a rare inherited disorder that causes vision and hearing loss. Balance issues may also occur. The symptoms for Usher syndrome are often congenital, or they develop during childhood – rarely are symptoms developed as an adult. There is no cure for Usher syndrome, and it affects between 3 to 6 out of every 100,000 people. 

There are three types of Usher syndrome, and we have a proposed code for each:

Q99.811 Usher syndrome, type 1 is proposed for type 1, wherein hearing loss and balance issues are present at the time of birth. In this type, vision issues may develop later in childhood, starting with a loss of night vision that gets progressively worse. 

Q99.812 Usher syndrome, type 2 is proposed for type 2, wherein babies are born with moderate to severe hearing loss, but don’t develop those balance issues that may affect them when they start to learn to walk. Vision issues may develop in the teenage years that will progress as they get older. 

Q99.813 Usher syndrome, type 3 is the code proposed for type 3. This type is very rare. Typical hearing and vision are noted at birth. Hearing loss begins in late childhood, and vision loss in early to mid-adulthood. Half of those with type 3 will also have balance problems. 

We also have proposed codes Q99.818, for Other Usher syndrome, and Q99.819, for Usher syndrome, unspecified.

Every week from here is a week that gets us closer to the Final Rule. 

Programming note: Listen live to the Coding Report today on Talk Ten Tuesday with Chuck Buck, 10 Eastern.