2025 ICD-10-CM code I26
(Active) Effective Date: N/A Diseases of the circulatory system - Pulmonary heart disease and diseases of pulmonary circulation IX Feed
Pulmonary embolism. Includes pulmonary (acute) (artery)(vein) infarction, pulmonary (acute) (artery)(vein) thromboembolism, and pulmonary (acute) (artery)(vein) thrombosis.
Medical necessity for I26 is established by the presence of signs, symptoms, and/or clinical findings consistent with PE, substantiated by objective diagnostic evidence such as positive imaging findings.
Diagnosis and treatment of pulmonary embolism typically falls under the purview of specialties like pulmonology, critical care, emergency medicine, internal medicine, and cardiology. Responsibilities include patient examination, diagnostic testing (e.g., CT angiography, V/Q scan), risk stratification, and initiation of appropriate therapy (e.g., anticoagulants, thrombolytics). For cases stemming from surgical complications, the surgeon assumes responsibility for addressing the resultant PE.
In simple words: A pulmonary embolism is a blockage in one of the pulmonary arteries in your lungs.In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from the legs or, rarely, other parts of the body (deep vein thrombosis).
Pulmonary embolism. Includes pulmonary (acute) (artery)(vein) infarction, pulmonary (acute) (artery)(vein) thromboembolism, and pulmonary (acute) (artery)(vein) thrombosis. Excludes1: cor pulmonale without embolism (I27.81). Excludes2: chronic pulmonary embolism (I27.82), personal history of pulmonary embolism (Z86.711), pulmonary embolism complicating abortion, ectopic or molar pregnancy (O00-O07, O08.2), pulmonary embolism complicating pregnancy, childbirth and the puerperium (O88.-), pulmonary embolism due to trauma (T79.0, T79.1), pulmonary embolism due to complications of surgical and medical care (T80.0, T81.7-, T82.8-), and septic (non-pulmonary) arterial embolism (I76).
Example 1: A 55-year-old patient presents to the ED with sudden onset shortness of breath and chest pain. After diagnostic tests, including a CT scan, a pulmonary embolism is confirmed., A 30-year-old woman on birth control pills develops a deep vein thrombosis (DVT) in her leg, which subsequently leads to a pulmonary embolism, requiring hospitalization for anticoagulation therapy., A 70-year-old post-surgical patient experiences difficulty breathing. Imaging reveals a small pulmonary embolism.
Documentation for I26 should include details of the diagnostic workup (e.g., imaging studies confirming PE such as CTPA or V/Q scan), location (e.g., saddle, lobar, segmental, subsegmental), presence/absence of acute cor pulmonale, and any underlying conditions contributing to PE (e.g., recent surgery, trauma, immobilization).
** It is essential to distinguish between acute and chronic pulmonary embolism when selecting the appropriate code.Additionally, for proper reimbursement and data analysis, correct assignment of diagnostic confidence indicators in outpatient settings is important.
- Specialties:Pulmonology, Critical Care, Emergency Medicine, Internal Medicine, Cardiology, Cardiovascular Surgery
- Place of Service:Inpatient Hospital, Emergency Room - Hospital, Office, Outpatient Hospital