ICD-10 Coding for Segmental Pulmonary Embolism(I26.99, I26.94)
Complete ICD-10-CM coding and documentation guide for Segmental Pulmonary Embolism. Includes clinical validation requirements, documentation requirements, and coding pitfalls.
Also known as:
Related ICD-10 Code Ranges
Complete code families applicable to Segmental Pulmonary Embolism
I26.0-I26.9Primary Range
Pulmonary embolism and infarction
This range includes codes for various types of pulmonary embolism, including segmental and subsegmental emboli.
Code Comparison: When to Use Each Code
Compare key differences between these codes to ensure accurate selection
| Code | Description | When to Use | Key Documentation |
|---|---|---|---|
| I26.99 | Other pulmonary embolism without acute cor pulmonale | Use when imaging confirms segmental PE without acute cor pulmonale. |
|
| I26.94 | Multiple subsegmental pulmonary embolism without acute cor pulmonale | Use when imaging confirms multiple subsegmental emboli. |
|
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 segmental pulmonary embolism
Essential facts and insights about Segmental Pulmonary Embolism
Primary ICD-10-CM Codes for segmental pulmonary embolism
Decision Criteria
clinical Criteria
- CTA confirms segmental emboli without acute cor pulmonale.
documentation Criteria
- Detailed imaging findings specifying segmental branches.
Applicable To
- Segmental pulmonary embolism
Excludes
- Subsegmental pulmonary embolism (I26.94)
Clinical Validation Requirements
- CTA showing filling defects in segmental branches
- Absence of acute cor pulmonale
Code-Specific Risks
- Misclassification if subsegmental emboli are also present
Coding Notes
- Ensure documentation specifies segmental location and absence of cor pulmonale.
I26.94 - Multiple subsegmental pulmonary embolism without acute cor pulmonale
Use when imaging confirms multiple subsegmental emboli.
Applicable To
- Subsegmental pulmonary embolism
Excludes
- Segmental pulmonary embolism (I26.99)
Clinical Validation Requirements
- CTA showing multiple subsegmental filling defects
- Absence of acute cor pulmonale
Coding Notes
Ensure documentation specifies subsegmental location and absence of cor pulmonale.
Ancillary Codes
Additional codes that should be used in conjunction with the main diagnosis codes when applicable.
Chronic pulmonary embolism
I27.82Differential Codes
Alternative codes to consider when ruling out similar conditions to the primary diagnosis.
Documentation & Coding Risks
Avoid these common documentation and coding issues when documenting Segmental 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: Potential misdiagnosis or inappropriate treatment., Regulatory: Non-compliance with documentation standards., Financial: Denials or reduced reimbursement.
Mitigation Strategy
Use detailed imaging reports, Train staff on documentation requirements
Impact
Reimbursement: Incorrect DRG assignment leading to potential underpayment., Compliance: Non-compliance with coding guidelines., Data Quality: Inaccurate clinical data affecting patient records.
Mitigation Strategy
Ensure documentation clearly distinguishes between acute and chronic components.
Impact
Misclassification of PE type leading to audit findings.
Mitigation Strategy
Ensure thorough documentation and use of correct codes.
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 Segmental Pulmonary Embolism, with expert answers to help guide accurate code selection and documentation.
Documentation Templates for Segmental Pulmonary Embolism
Use these documentation templates to ensure complete and accurate documentation for Segmental Pulmonary Embolism. These templates include all required elements for proper coding and billing.
Radiology Report for Segmental PE
Specialty: RadiologyRequired Elements
- Location of emboli
- Presence of cor pulmonale
- Chronicity
Example Documentation
Examples: Poor vs. Good Documentation
Poor Documentation Example
Good Documentation Example
Explanation
Need help with ICD-10 coding for Segmental Pulmonary Embolism? Ask your questions below.