ICD-10 Coding for Pulmonary Embolism Unspecified(I26.99)
Complete ICD-10-CM coding and documentation guide for Pulmonary Embolism Unspecified. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Pulmonary Embolism Unspecified
I26.0-I26.99Primary Range
Pulmonary embolism and other pulmonary embolisms
This range includes all codes related to pulmonary embolism, including unspecified cases.
Key Information: ICD-10 code for pulmonary embolism unspecified
Essential facts and insights about Pulmonary Embolism Unspecified
Primary ICD-10-CM Code for pulmonary embolism unspecified
Decision Criteria
clinical Criteria
- CT angiography confirms PE without acute cor pulmonale.
Applicable To
- Unspecified pulmonary embolism
Excludes
- Pulmonary embolism with acute cor pulmonale (I26.01)
Clinical Validation Requirements
- CT pulmonary angiography confirming PE
- Absence of acute cor pulmonale on echocardiogram
Code-Specific Risks
- Risk of under-coding if more specific details are available but not documented.
Coding Notes
- Ensure documentation specifies the absence of acute cor pulmonale.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Personal history of pulmonary embolism
Z86.711Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Septic pulmonary embolism with acute cor pulmonale
I26.01Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Pulmonary Embolism Unspecified to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I26.99.
Impact
Clinical: May lead to inappropriate treatment decisions., Regulatory: Increased risk of audit and denial., Financial: Potential for incorrect billing and reimbursement.
Mitigation Strategy
Educate providers on documentation specificity., Use templates to guide documentation.
Impact
Reimbursement: Incorrect DRG assignment leading to potential underpayment., Compliance: Risk of audit due to lack of specificity., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Query provider to specify if PE is acute or chronic.
Impact
High risk of audit if more specific codes are applicable.
Mitigation Strategy
Ensure thorough documentation and use of specific codes when possible.
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 Unspecified, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Pulmonary Embolism Unspecified
Use these documentation templates to ensure complete and accurate documentation for Pulmonary Embolism Unspecified. These templates include all required elements for proper coding and billing.
Acute PE without cor pulmonale
Specialty: PulmonologyRequired Elements
- Acuity of PE
- Imaging results
- Treatment plan
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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