Is ICD-10-CM code I26 billable?

No, I26 (Pulmonary embolism) is a non-billable ICD-10-CM code. It must be coded to a more specific subcategory before it can be used for reimbursement.

What chapter does ICD-10-CM code I26 belong to?

I26 belongs to Chapter 9 of the ICD-10-CM tabular list: I00–I99 (Diseases of the Circulatory System).

I26Not billable, use a more specific code below

Pulmonary embolism

In Pulmonary heart disease and diseases of pulmonary circulation (I26-I28), chapter 9: Diseases of the Circulatory System

12 billable codes under I26: all are an MCC; all map to HCC 267 (Deep Vein Thrombosis and Pulmonary Embolism).A CC or MCC (major CC) is a secondary diagnosis that raises the MS-DRG payment. An HCC counts toward a Medicare Advantage patient's risk score.

Instructional notes

Includes: conditions that are coded here

pulmonary (acute) (artery)(vein) infarction
pulmonary (acute) (artery)(vein) thromboembolism
pulmonary (acute) (artery)(vein) thrombosis

Excludes1: not coded here, use a different code

cor pulmonale without embolism (I27.81)

Excludes2: not included here, code separately if applicable

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)

Official coding guidelines

From the ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (CMS and NCHS). Links open the PDF at the right page.

Covers hypertension with heart and kidney disease, coronary artery disease with angina, perioperative stroke, cerebrovascular sequelae, and acute myocardial infarction types and timing.

Hypertension (page 50)
Atherosclerotic Coronary Artery Disease and Angina (page 52)
Intraoperative and Postprocedural Cerebrovascular Accident (page 53)
Sequelae of Cerebrovascular Disease (page 53)
Acute myocardial infarction (AMI) (page 54)

Read Section I.C.9 (page 50)

All codes under I26

I26 can't be used on a claim. Pick a billable code below; grey headings group them.

I26 MS-DRGs

As the principal diagnosis, all 12 billable codes under I26 group to MS-DRG 173, 175, 176, 791, or 793 (v44.0). Which one applies depends on procedures performed, secondary diagnoses (CC/MCC), and the patient's age and discharge status.

Other codes that refer to I26

Notes on these codes point to I26.

I27.24 Code Also: associated pulmonary embolism, if applicable (I26.-, I27.82)
I5A Code First: pulmonary embolism (I26.-)
I74 Excludes2: pulmonary embolism and thrombosis (I26.-)
I82 Excludes2: pulmonary (I26.-)
U09.9 Code First: pulmonary embolism (I26.-)

About the condition

Plain-language background from MedlinePlus (National Library of Medicine), not coding guidance.

Pulmonary Embolism

A pulmonary embolism (PE) is a sudden blockage in a lung artery. It usually happens when a blood clot breaks loose and travels through the bloodstream to the lungs. PE is a serious condition that can cause:

Code history

Valid since FY2016, when ICD-10-CM took effect on October 1, 2015. No changes since.