ICD-10 Coding for Pulmonary Embolism(I26.01, I26.94, I27.82)
Complete ICD-10-CM coding and documentation guide for Pulmonary Embolism. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pulmonary Embolism
I26-I28Primary Range
Pulmonary heart disease and diseases of pulmonary circulation
This range includes codes for pulmonary embolism and related conditions such as cor pulmonale.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I26.01 | Septic pulmonary embolism with acute cor pulmonale | Use when septic PE is confirmed with acute cor pulmonale. |
|
| I26.94 | Multiple subsegmental pulmonary emboli without acute cor pulmonale | Use for multiple subsegmental PEs without cor pulmonale. |
|
| I27.82 | Chronic pulmonary embolism | Use for chronic PE with organized thrombi. |
|
Clinical Decision Support
Always review the patient's clinical documentation thoroughly. When in doubt, choose the more specific code and ensure documentation supports it.
Key Information: ICD-10 code for pulmonary embolism
Essential facts and insights about Pulmonary Embolism
Primary ICD-10-CM Codes for pulmonary emboli
Decision Criteria
clinical Criteria
- Presence of acute cor pulmonale confirmed by imaging
Applicable To
- Septic PE with acute right heart failure
Excludes
- Chronic pulmonary embolism (I27.82)
Clinical Validation Requirements
- Positive blood cultures
- RV strain on echocardiogram
Code-Specific Risks
- Incorrectly coding without confirming acute cor pulmonale
Coding Notes
- Ensure documentation specifies 'acute' and 'septic' with cor pulmonale.
I26.94 - Multiple subsegmental pulmonary emboli without acute cor pulmonale
Use for multiple subsegmental PEs without cor pulmonale.
Applicable To
- Multiple subsegmental filling defects
Excludes
- Chronic pulmonary embolism (I27.82)
Clinical Validation Requirements
- CTPA showing subsegmental defects
Coding Notes
Document specific location and number of emboli.
I27.82 - Chronic pulmonary embolism
Use for chronic PE with organized thrombi.
Applicable To
- Organized thrombi in pulmonary arteries
Excludes
- Acute pulmonary embolism (I26.99)
Clinical Validation Requirements
- Imaging showing organized thrombus
- Long-term anticoagulation
Coding Notes
Ensure documentation specifies 'chronic' and 'organized thrombi'.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Long term (current) use of anticoagulants
Z79.01Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Septic pulmonary embolism without acute cor pulmonale
I26.90Single subsegmental pulmonary embolism without acute cor pulmonale
I26.93Other pulmonary embolism without acute cor pulmonale
I26.99Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Pulmonary Embolism to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I26.01.
Impact
Clinical: Potential mismanagement of patient care, Regulatory: Non-compliance with coding standards, Financial: Loss of appropriate reimbursement
Mitigation Strategy
Always specify acute or chronic, Include imaging findings
Impact
Reimbursement: Incorrect DRG assignment, Compliance: Non-compliance with coding guidelines, Data Quality: Inaccurate clinical data
Mitigation Strategy
Verify chronicity through imaging and treatment history.
Impact
Misclassification of PE acuity can lead to audit discrepancies.
Mitigation Strategy
Regular training on documentation and coding guidelines.
Documentation errors, coding pitfalls, and audit risks are interconnected aspects of medical coding and billing. Addressing all three areas helps ensure accurate coding, optimal reimbursement, and regulatory compliance.
Frequently Asked Questions
Common questions about ICD-10 coding for Pulmonary Embolism, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pulmonary Embolism
Use these documentation templates to ensure complete and accurate documentation for Pulmonary Embolism. These templates include all required elements for proper coding and billing.
Acute PE with cor pulmonale
Specialty: Emergency MedicineRequired Elements
- Acuity of PE
- Presence of cor pulmonale
- Imaging results
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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