I26.01: Septic pulmonary embolism with acute cor pulmonale
I26.01 is a billable, specific ICD-10-CM code for septic pulmonary embolism with acute cor pulmonale. It is valid for submission on a claim.
Check I26.01 with the rest of the claim: free scrubberCode first
The underlying condition must be sequenced before this code.
- underlying infection
Excludes1 inherited from the categories above I26.01
A category’s note binds every code beneath it.
Excludes2 inherited from the categories above I26.01
Not part of this code, but both may be coded when both are present.
Written on I26: Pulmonary embolism
- 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-)
- septic (non-pulmonary) arterial embolism (I76)
Risk adjustment
I26.01 risk-adjusts. Under the CMS-HCC V28 model it maps to this category:
- HCC 267 Deep Vein Thrombosis and Pulmonary Embolism0.294 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
I26.01 is named in 26 Medicare coverage policies: 26 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
- A52868Billing and Coding: Transesophageal Echocardiography (TEE)
- A52993Billing and Coding: Peripheral Venous Ultrasound
- A56476Billing and Coding: Cardiac Radionuclide Imaging
Alphabetic index entries that lead here
- Embolism›pulmonary›septic›with acute cor pulmonale
Code history
Unchanged in every release from FY2024 to FY2027.