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v1.0.0
ICD-10 Guide
DiagnosesAcute Pulmonary Embolism

Acute Pulmonary Embolism

ICD-10 Coding for Acute Pulmonary Embolism(I26.01, I26.02, I26.93)

PRIMARY SPECIALTYEmergency Medicine
COMPLEXITYHigh
LAST UPDATED09/15/2025
Sam Tuffun, PT, DPT
Physical Therapist | Medical Coding & Billing Contributor

Diagnosis Overview

What is Acute Pulmonary Embolism?
Essential facts and insights about Acute Pulmonary Embolism

Key Clinical Considerations:

  • Acute onset of dyspnea, chest pain, or hemoptysis
  • Elevated D-dimer levels indicating possible thromboembolism
  • Physical examination may reveal tachycardia, hypoxia, or signs of deep vein thrombosis
  • CT pulmonary angiography showing occlusion of pulmonary arteries
  • Severity may be assessed using the Pulmonary Embolism Severity Index (PESI) or simplified PESI

Clinical Information

Clinical Criteria & Documentation Requirements

  • Document the patient's presenting symptoms and clinical history
  • Use specific terminology such as 'acute pulmonary embolism' rather than vague terms
  • Examples include: 'Patient presents with acute chest pain and shortness of breath, CT angiography confirms PE'
  • Document medical necessity for imaging and treatments provided
  • Include quality measures such as timely administration of anticoagulation therapy

Coding Guidelines

Usage Guidelines & Examples

  • Use I26.01 for acute pulmonary embolism with acute cor pulmonale; I26.02 for acute pulmonary embolism without acute cor pulmonale
  • Do not use these codes for chronic pulmonary embolism or other unrelated conditions
  • Compare with I26.9 (unspecified pulmonary embolism) for cases lacking specificity
  • Common errors include misclassifying chronic conditions as acute; ensure clinical criteria are met
  • In complex cases, consider the patient's history and presenting symptoms to select the most accurate code

Code Exclusions

Important Exclusions

  • Chronic pulmonary embolism (I27.0) is explicitly excluded from this coding
  • Use I26.9 for unspecified pulmonary embolism when the specific type is not documented
  • Conditions like pneumonia or heart failure may mimic PE symptoms but are distinct
  • Avoid confusion between acute and chronic conditions in documentation
  • Related conditions such as pulmonary hypertension (I27.2) should not be coded as PE

Related ICD-10 Codes

Primary Codes
I26.01
Acute pulmonary embolism with acute cor pulmonale
I26.02
Acute pulmonary embolism without acute cor pulmonale
Ancillary Codes
B95.61
Differential Codes
I26.02
I26.93
I26.01

Related CPT Codes

CPT codes will be available in a future update.

Specialty Focus

Primary Specialty

Emergency Medicine

Specialty Applications

  • Patients with risk factors such as recent surgery, prolonged immobility, or history of venous thromboembolism
  • Applicable to all age groups, with increased risk in older adults and those with certain comorbidities
  • Clinical settings include emergency departments, inpatient care, and outpatient follow-up
  • Emergency medicine specialists frequently encounter this diagnosis in acute care settings
  • Used in treatment contexts involving anticoagulation therapy and potential thrombolysis

Coding Complexity

High Complexity

This diagnosis requires careful attention to:

  • Comprehensive clinical documentation
  • Accurate code selection based on clinical criteria
  • Proper exclusion considerations
  • Specialty-specific coding guidelines

Documentation

Documentation Templates

Template 1

Template: 'Patient diagnosed with acute pulmonary embolism based on CT findings and clinical presentation.'

Template 2

Template: 'Clinical presentation consistent with acute pulmonary embolism including dyspnea and chest pain.'

Template 3

Template: 'Diagnostic criteria met as evidenced by CT angiography showing occlusion of pulmonary arteries.'

Template 4

Template: 'Treatment plan initiated for acute pulmonary embolism with anticoagulation therapy.'

Template 5

Template: 'Follow-up care for acute pulmonary embolism including monitoring of D-dimer levels and symptoms.'

Billing Information

Billing Considerations

  • Ensure proper documentation for billing
  • Verify code specificity requirements
  • Check for any additional codes needed
  • Review payer-specific guidelines

Common Issues

  • Insufficient clinical documentation
  • Incorrect code selection
  • Missing supporting diagnoses
  • Timing and frequency documentation

Frequently Asked Questions

What documentation is required for this diagnosis?

Document presenting symptoms, diagnostic imaging results, and treatment plans.

How does this differ from similar diagnoses?

Acute pulmonary embolism is characterized by sudden onset and specific imaging findings, unlike chronic conditions.

What are common billing considerations?

Ensure documentation supports medical necessity for imaging and treatments to optimize reimbursement.

What procedures are typically associated?

CPT codes for CT pulmonary angiography and anticoagulation therapy are commonly associated.

Are there any quality reporting implications?

Quality measures include timely treatment initiation and follow-up care documentation.