I’ve been training coders for over 25 years, and it’s impossible to say how many times I’ve told coders to “trust the Index” when it comes to ICD-10-CM coding. I have even told coders that if they like shopping, this isn’t the coding system for them because we can’t “shop” through the Tabular List. Then again, I’ve also been quoted as saying, “Here are the rules. These are always the rules… and here’s a list of exceptions.” Consider the second quarter 2026 issue of Coding Clinic one of those exceptions.

The truth is, the ICD-10-CM Alphabetic Index is still one of the most valuable tools we have. In the vast majority of cases, it leads us to the correct code. But every so often, we encounter situations where the Index points us in one direction while the provider’s documentation tells a different story. Those are the moments that separate simply looking up codes from truly understanding how to code. In those situations, our job isn’t to ignore the Index – it’s to recognize when the documented clinical picture doesn’t support where the Index initially leads us.

If these kinds of coding scenarios make you pause, you’re not alone. They’re exactly the types of questions we’ll tackle in our upcoming webinar, ICD-10 Coding Updates Q2 2026, where we’ll break down the latest Coding Clinic guidance and discuss the reasoning behind the official advice.

Together, we’ll explore questions such as:

• Should hyperlactatemia automatically be coded as lactic acidosis?
• If a newborn has poor respiratory effort, does that automatically mean respiratory failure?
• What should you do when documentation in the ED record says the patient has “RSV infection” without an associated respiratory condition?
• Why isn’t lichen planus of the esophagus coded the same way as lichen planus of the skin, even though that’s where the Alphabetic Index initially leads?

These examples all reinforce an important lesson: the Alphabetic Index is an essential coding tool, but our job isn’t simply to follow an Index entry. Our job is to tell the patient’s story through codes by accurately reflecting the provider’s documentation while applying the ICD-10-CM guidelines and conventions.

Of course, those aren’t the only topics we’ll cover in this webinar. We’ll also discuss Coding Clinic guidance on obstetrics, musculoskeletal conditions, chronic kidney disease, ICD-10-PCS procedures, and a few correction notices every coder should know about.

This webinar is designed to take you deeper than the published advice. We’ll explain the diseases, procedures, and coding concepts behind each scenario, using illustrations and real-world examples to connect the clinical documentation to the correct code assignment. Our goal isn’t just to tell you the right answer – it’s to help you understand why it’s the right answer.

Because sometimes the biggest coding lesson isn’t learning a new code. It’s learning when to pause, ask questions, look beyond the Index, and make sure the codes accurately tell the patient’s story.