Is I26.94 a billable ICD-10-CM code?

Yes. I26.94 is a billable, specific ICD-10-CM code and is valid for submission on a claim.

Where does I26.94 sit in the tabular list?

Diseases of the circulatory system (I00-I99), in the block Pulmonary heart disease and diseases of pulmonary circulation (I26-I28).

What cannot be coded together with I26.94?

I26.94 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above I26.94 (I26) and apply to it just the same.

I26.94

I26.94 — Multiple subsegmental thrombotic pulmonary emboli without acute cor pulmonale

Billable / specific codeICD-10-CM

I26.94 is a billable, specific ICD-10-CM code for multiple subsegmental thrombotic pulmonary emboli without acute cor pulmonale. It is valid for submission on a claim.

Excludes1 inherited from the categories above I26.94

These are not written on I26.94, but they bind it: a note on a category applies to every code beneath it. Billing I26.94 with anything listed here is a denial.

Written on I26 — Pulmonary embolism

cor pulmonale without embolism (I27.81)

Excludes2 inherited from the categories above I26.94

Also inherited, and the opposite of Excludes1: these conditions are not part of I26.94, but a patient can have both, so you may code both.

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

I26.94 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.

Medicare coverage

I26.94 is named in 43 Medicare coverage policies — 43 listing it as supporting medical necessity. Which of them applies to you depends on your Medicare contractor, and coverage genuinely differs by state.

A52868Billing and Coding: Transesophageal Echocardiography (TEE)
A52993Billing and Coding: Peripheral Venous Ultrasound
A56476Billing and Coding: Cardiac Radionuclide Imaging
A56500Billing and Coding: Cardiac Catheterization and Coronary Angiography

How I26.94 is indexed

Coders do not find codes by browsing the tabular list — they look them up in the alphabetic index, under the word the physician wrote. These are the index entries that lead here, so you can see which chart wordings map to I26.94.

Embolism›pulmonary›multiple subsegmental without acute cor pulmonale

Code history

What changed, and when. Derived by diffing consecutive CMS release files — which matters when you are defending a code assigned under an earlier edition.

revisedFY2024-FY2026
Multiple subsegmental pulmonary emboli without acute cor pulmonale → Multiple subsegmental thrombotic pulmonary emboli without acute cor pulmonale

Related codes at this level

Codes that share I26.9. If I26.94 is not quite right, the correct code is usually one of these.

Questions about I26.94

Is I26.94 a billable ICD-10-CM code?: Yes. I26.94 is a billable, specific ICD-10-CM code and is valid for submission on a claim.
Where does I26.94 sit in the tabular list?: Diseases of the circulatory system (I00-I99), in the block Pulmonary heart disease and diseases of pulmonary circulation (I26-I28).
What cannot be coded together with I26.94?: I26.94 carries Excludes1 notes, which means the conditions they list can never be coded together with it on the same encounter. Some are written on the categories above I26.94 (I26) and apply to it just the same.