ICD-10 Coding for Acute Pulmonary Embolism(I26.01, I26.02, I26.93)
Complete ICD-10-CM coding and documentation guide for Acute Pulmonary Embolism. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Acute Pulmonary Embolism
I26Primary Range
Pulmonary embolism
This range includes all codes related to pulmonary embolism, both acute and chronic, with or without 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 pulmonary embolism is confirmed with acute cor pulmonale. |
|
| I26.02 | Saddle pulmonary embolism with acute cor pulmonale | Use when a saddle embolus is confirmed with acute cor pulmonale. |
|
| I26.93 | Single subsegmental pulmonary embolism without acute cor pulmonale | Use when a single subsegmental embolus is confirmed without cor pulmonale. |
|
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 acute pulmonary embolism
Essential facts and insights about Acute Pulmonary Embolism
Primary ICD-10-CM Codes for acute pulmonary embolism
Decision Criteria
clinical Criteria
- Presence of septicemia and acute cor pulmonale
Applicable To
- Septic pulmonary embolism with acute right heart strain
Excludes
- Chronic pulmonary embolism (I27.82)
Clinical Validation Requirements
- Documented organism causing sepsis
- Evidence of acute cor pulmonale via echocardiogram
Code-Specific Risks
- Incorrectly coding without evidence of cor pulmonale
Coding Notes
- Ensure documentation specifies both the septic nature and the presence of acute cor pulmonale.
I26.02 - Saddle pulmonary embolism with acute cor pulmonale
Use when a saddle embolus is confirmed with acute cor pulmonale.
Applicable To
- Saddle embolus with acute right heart strain
Excludes
- Chronic pulmonary embolism (I27.82)
Clinical Validation Requirements
- Imaging confirmation of saddle embolus
- Evidence of acute cor pulmonale
Coding Notes
Ensure imaging reports confirm the presence of a saddle embolus.
I26.93 - Single subsegmental pulmonary embolism without acute cor pulmonale
Use when a single subsegmental embolus is confirmed without cor pulmonale.
Applicable To
- Subsegmental embolus without right heart strain
Excludes
- Chronic pulmonary embolism (I27.82)
Clinical Validation Requirements
- CTPA showing single subsegmental embolus
- Negative echocardiogram for right heart strain
Coding Notes
Ensure documentation specifies the subsegmental nature and absence of cor pulmonale.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Staphylococcus aureus as the cause of diseases classified elsewhere
B95.61Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Saddle pulmonary embolism with acute cor pulmonale
I26.02Single subsegmental pulmonary embolism without acute cor pulmonale
I26.93Septic pulmonary embolism with acute cor pulmonale
I26.01Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Acute 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: Leads to ambiguity in patient care and treatment plans., Regulatory: Non-compliance with ICD-10 coding standards., Financial: Potential for denied claims and reduced reimbursement.
Mitigation Strategy
Always specify the type and acuity of PE in documentation.
Impact
Reimbursement: Incorrect coding can lead to improper DRG assignment and reimbursement., Compliance: May result in non-compliance with coding guidelines., Data Quality: Affects the accuracy of clinical data and patient records.
Mitigation Strategy
Always document and code the presence or absence of cor pulmonale.
Impact
Risk of incorrect coding without proper documentation of septicemia and cor pulmonale.
Mitigation Strategy
Implement regular audits and provider education on documentation requirements.
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 Acute Pulmonary Embolism, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Acute Pulmonary Embolism
Use these documentation templates to ensure complete and accurate documentation for Acute Pulmonary Embolism. These templates include all required elements for proper coding and billing.
Acute PE in Emergency Department
Specialty: Emergency MedicineRequired Elements
- Confirmation of PE via imaging
- Presence or absence of cor pulmonale
- Treatment plan and anticoagulation details
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Acute Pulmonary Embolism? Ask your questions below.