ICD-10 Coding for Submassive Pulmonary Embolism(I26.99)
Complete ICD-10-CM coding and documentation guide for Submassive Pulmonary Embolism. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Submassive Pulmonary Embolism
I26.0-I26.9Primary Range
Pulmonary embolism and other pulmonary vascular diseases
This range includes codes for various types of pulmonary embolism, including submassive PE.
Key Information: ICD-10 code for submassive pulmonary embolism
Essential facts and insights about Submassive Pulmonary Embolism
Primary ICD-10-CM Code for submassive pulmonary embolism
Decision Criteria
clinical Criteria
- Presence of RV dysfunction without hypotension
Applicable To
- Submassive pulmonary embolism without acute cor pulmonale
Excludes
- Pulmonary embolism with acute cor pulmonale (I26.09)
Clinical Validation Requirements
- RV/LV ratio >0.9 on CT
- Elevated troponin >0.1 ng/mL
- Echocardiographic findings of RV dysfunction
Code-Specific Risks
- Misclassification as massive PE if hypotension is present.
Coding Notes
- Ensure documentation specifies RV dysfunction and absence of hypotension.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Abnormal findings on diagnostic imaging of heart and coronary circulation
R94.31Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Pulmonary embolism with acute cor pulmonale
I26.09Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Submassive Pulmonary Embolism to ensure proper reimbursement, maintain compliance, and reduce audit risk. These guidelines are particularly important when using ICD-10 code I26.99.
Impact
Clinical: Misclassification of PE severity., Regulatory: Potential audit issues., Financial: Incorrect DRG assignment affecting reimbursement.
Mitigation Strategy
Ensure all imaging and biomarker results are documented.
Impact
Reimbursement: Incorrect DRG assignment leading to reimbursement issues., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Verify duration of anticoagulation and document acuity.
Impact
Inadequate documentation of RV dysfunction can lead to audit failures.
Mitigation Strategy
Ensure comprehensive documentation of imaging and biomarker findings.
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 Submassive Pulmonary Embolism, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Submassive Pulmonary Embolism
Use these documentation templates to ensure complete and accurate documentation for Submassive Pulmonary Embolism. These templates include all required elements for proper coding and billing.
Emergency Department Note
Specialty: Emergency MedicineRequired Elements
- Assessment of RV dysfunction
- Troponin levels
- CT findings
- Blood pressure status
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
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