Use This Guide to Accurately Code Pulmonary Embolism Diagnoses
Receive a PE condition breakdown. Pulmonary embolism (PE) is a life-threatening condition affecting the patient’s lungs and the oxygenation of the blood. The ailment can include bacterial infection, body fat, or affect multiple arterial branches. As a pulmonology coder, you need to know how to report the correct diagnosis to ensure accurate reimbursement for the physician. Continue reading to learn about PE and the associated diagnosis codes. Recognize PE Symptoms A PE occurs when a blood clot or multiple clots in another part of the patient’s body comes loose and travels through the bloodstream to the lung. The clot gets stuck and obstructs blood flow to the lungs, which decreases the oxygenation of the blood and raises the pulmonary arteries’ blood pressure. Patients suffering from PE may experience any of the following symptoms: PEs can develop in several ways, and the condition is a medical emergency requiring immediate attention. Identify the ICD-10-CM PE Codes PE codes are listed under the I26.- (Pulmonary embolism) code category in the ICD-10-CM code book. Codes in the category require 4th and 5th characters for completion. The subcategories I26.0- (Pulmonary embolism with acute cor pulmonale) and I26.9- (Pulmonary embolism without acute cor pulmonale) differ in whether the physician determines the patient is experiencing right-sided heart failure (cor pulmonale) due to the PE. The right ventricle sends blood to the pulmonary artery for oxygenation from the lungs, but if the PE becomes lodged in the pulmonary artery, then the blood pressure increases in the pulmonary artery. This leads to the right ventricle working harder to move blood to the lungs, forcing the ventricle to grow, which can cause heart failure. Under the I26.0- subcategory, you’ll find the following PE with acute cor pulmonale codes: Look to the I26.9- subcategory when the physician diagnoses the patient with PE without acute cor pulmonale. The I26.9- codes include: Understand the Different PE Conditions Septic PE: A septic PE occurs when a blood clot infected with bacteria travels to the lungs. Assign I26.01 when the patient experiences acute right heart failure and use I26.90 if the physician diagnoses the patient with septic PE without acute cor pulmonale. Plus, both codes also feature a Code first note instructing you to report a code identifying the infection. Saddle PE: When the patient experiences a large blood clot that becomes lodged at the split of the main pulmonary artery, it is known as a saddle embolus. This is a life-threatening condition because the clot blocks blood flow to the lungs. Use I26.02 for a diagnosis of a saddle embolus with right-sided heart failure, and assign I26.92 for a saddle embolus diagnosis without cor pulmonale. Subsegmental PE: Assign codes I26.93 and I26.94 for single subsegmental thrombotic PE and multiple subsegmental thrombotic pulmonary emboli, respectively. A single subsegmental thrombotic PE occurs when a small clot is obstructing a small lung artery, while a multiple subsegmental thrombotic pulmonary emboli describes several small clots in the small branches of the pulmonary arteries. Fat PE: Two new codes to the ICD-10-CM code book in 2025 are I26.04 and I26.96. These codes are designated for fat PE with and without cor pulmonale, respectively. “A fat embolism is when one or more droplet-like particles of fat enter the bloodstream and embolize through the systemic or pulmonary circulation,” said Jill Young, CEDC, CPC, CEMC, CIMC, of Young Medical Consulting, LLC in East Lansing, Michigan, during her “ICD-10-CM Updates 2025” webinar. She added, “Fat emboli can form when an individual breaks a bone, particularly with more severe or complex fractures. Long bone and pelvic fractures are the most frequent causes.” Fat emboli can occur during other medical conditions, such as burns, following liposuction, orthopedic surgeries, and even after cardiopulmonary resuscitation (CPR). Both codes include Code first notes if the accompanying situations apply: Assign T81.718- (Complication of other artery following a procedure, not elsewhere classified) with an appropriate 7th character if the fat embolism develops after a procedure. Use T79.1- (Fat embolism (traumatic)) to report the fat embolism. Cement PE: This condition occurs when polymethylmethacrylate (PMMA) embolizes in the bloodstream following vertebral or arthroplasty procedures. The two codes, I26.03 and I26.95, are also new to the ICD-10-CM code book in 2025. Cement PE develops when the PMMA leaks into the blood vessels and then hardens in the pulmonary vasculature. “Cement PE involves a mechanical occlusion of the pulmonary arteries and not a vascular-type clot,” Young said. Codes I26.03 and I26.95 also feature Code first notes instructing you to assign T81.718- to report the condition as a post-procedure complication. Put Your Knowledge Into Action Scenario: A 65-year-old patient reported to the emergency department (ED) with sudden onset of SOB, chest pain that worsened on deep breathing or coughing, and a sense of anxiety. The patient also reported a recent history of prolonged immobility due to a fractured hip. The pulmonologist performed a D-dimer test and observed elevated levels. A CT angiography confirmed a substantial blood clot presence in the right pulmonary artery. An echocardiogram (ECG) showed signs of strain on the right side of the heart. The pulmonologist diagnosed the patient with saddle PE without cor pulmonale. Use 85378 (Fibrin degradation products, D-dimer; qualitative or semiquantitative) to report the D-dimer test. You’ll assign 71275 (Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing) to report the CT angiography of the pulmonary arteries. Lastly, report 93306 (Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography) for the echocardiogram used to assess the PE’s impact on the patient’s heart. For the saddle PE without cor pulmonale, you’ll assign I26.92. Mike Shaughnessy, BA, CPC, Development Editor, AAPC
