What does ICD-10-CM code I26.99 mean?
I26.99 represents Other pulmonary embolism without acute cor pulmonale. This cardiovascular condition is classified under Chapter 9 (Diseases of the Circulatory System) and is one of the most commonly coded circulatory system diagnoses. Coders frequently reference this code as pe icd 10 or pe.
This diagnosis qualifies as a Major Complication or Comorbidity (MCC) under the MS-DRG system, which significantly impacts inpatient reimbursement. Depending on the clinical diagnosis, management may involve tinzaparin, papaverine, edoxaban. Refer to current clinical guidelines and provider documentation for treatment decisions.
Code category and hierarchy
- Chapter: 9 – Diseases of the Circulatory System (I00-I99)
- Category: I26
- Code: I26.99 – Other pulmonary embolism without acute cor pulmonale
Guideline notes and coding considerations
Important Guideline Note
I26.99 is a Major Complication or Comorbidity (MCC). Ensure clinical documentation clearly supports the diagnosis severity and specificity.
- Excludes1: cor pulmonale without embolism ( I27.81 )
Learn the underlying rules in the ICD-10 Coding Guidelines, Combination Code Requirements, Risk Adjustment & MEAT Documentation.
Documentation tips (what coders should confirm)
- Verify the clinical documentation supports the use of I26.99
- Query the provider for greater specificity if clinical details suggest a more precise code
- This code is an MCC — ensure documentation clearly supports the diagnosis severity
- This is a risk-adjusted diagnosis — ensure annual documentation with MEAT criteria (Monitor, Evaluate, Assess/Address, Treat)
When NOT to use I26.99
Do not assign I26.99 when the clinical scenario involves: cor pulmonale without embolism ( I27.81 ). Review excludes notes and assign the most specific code supported by documentation.
Audit risk
As an MCC, I26.99 significantly increases DRG weight. Auditors closely review MCC codes to ensure documentation clearly supports the clinical severity. Ensure the condition is confirmed (not suspected) and actively managed during the encounter.
Validate I26.99 Against ICD 10 CM Coding Guidelines
Check this code against official guidelines for conflicts and compliance issues.
Risk adjustment and HCC mapping
HCC Impact
I26.99 (Other pulmonary embolism without acute cor pulmonale) maps to the following HCC categories: CMS-HCC V24: HCC 107, CMS-HCC V28: HCC 267, RxHCC V08: HCC 215, ESRD V24: HCC 107. Proper documentation using MEAT criteria (Monitor, Evaluate, Assess/Address, Treat) is required for each encounter to support risk-adjusted diagnoses.
Learn more about risk adjustment documentation in our Risk Adjustment & MEAT Documentation Guide.
Related ICD-10 codes
Frequently Asked Questions
The ICD-10-CM code for pe is I26.99, which represents other pulmonary embolism without acute cor pulmonale. This code is also commonly referenced as pe. Verify this code using the ICD Code Auditor to ensure guideline compliance.
Yes. I26.99 is an active ICD-10-CM diagnosis code used to classify other pulmonary embolism without acute cor pulmonale for clinical documentation, reporting, and medical billing purposes.
Use the ICD Code Auditor to check I26.99 against official ICD-10-CM coding guidelines. The tool validates by fiscal year and patient gender to identify potential conflicts.
Yes. I26.99 (Other pulmonary embolism without acute cor pulmonale) qualifies as an MCC under the MS-DRG system, which can significantly impact inpatient hospital reimbursement by increasing the DRG weight.
Yes. I26.99 maps to HCC 107 in the CMS-HCC V24 model, and HCC 267 in V28. Accurate coding of this condition directly impacts RAF scores for Medicare Advantage plans. Ensure documentation demonstrates the condition was evaluated and managed during the encounter.
Documentation should clearly describe the clinical condition represented by I26.99 (Other pulmonary embolism without acute cor pulmonale). Include relevant clinical findings, diagnostic test results, provider assessment, and the treatment plan. The diagnosis must be supported by the medical record and not based solely on lab results without clinical interpretation.
Sources
Reviewed by: Certified ICD-10 Coding & Risk Adjustment Specialist
Learn more about our Clinical Coding Review Process