I26 ICD-10-CM Code: Pulmonary embolism
I26 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)
I26
Header CodeICD-10-CMOfficial ICD-10-CMCodebook guidancePulmonary embolism
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
N/A—
Not mapped
ESRD/PACE
N/A—
Not mapped
RXHCC
N/A—
Not mapped
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for I26. Check the code and parent instructions in the Code Book.
Excludes 2
Official- 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)
- certain conditions originating in the perinatal period (P04-P96)Inherited from I00-I99
- certain infectious and parasitic diseases (A00-B99)Inherited from I00-I99
- complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from I00-I99
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from I00-I99
- endocrine, nutritional and metabolic diseases (E00-E88)Inherited from I00-I99
- injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from I00-I99
- neoplasms (C00-D49)Inherited from I00-I99
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from I00-I99
- systemic connective tissue disorders (M30-M36)Inherited from I00-I99
- transient cerebral ischemic attacks and related syndromes (G45.-)Inherited from I00-I99
Related Codes
Includes
Official- pulmonary (acute) (artery)(vein) infarction
- pulmonary (acute) (artery)(vein) thromboembolism
- pulmonary (acute) (artery)(vein) thrombosis
Excludes 1
Official- cor pulmonale without embolism (I27.81)
Code First
OfficialNo Code First sequencing instructions are included in this display for I26. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for I26. Check the code and parent instructions in the Code Book.
Code Also
OfficialNo Code Also instructions are included in this display for I26. Check the code and parent instructions in the Code Book.
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
- Code
- I26
- Description
- Pulmonary embolism
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- No
- Payment year
- 2026
Coder workflow notes
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What This Code Means
I26 is the ICD-10-CM diagnosis code for pulmonary embolism. I26 sits in the ICD-10-CM chapter for diseases of the circulatory system (i00-i99), within the section covering pulmonary heart disease and diseases of pulmonary circulation (i26-i28).
Header codes like I26 cannot be reported on claims directly; they organize child codes that share clinical context. Coders should select the billable child code that matches the documented presentation and then verify its current source-backed HCC mapping. Do not infer a child code or risk adjustment value from the header alone.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I26 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Includes
- pulmonary (acute) (artery)(vein) infarction
- pulmonary (acute) (artery)(vein) thromboembolism
- pulmonary (acute) (artery)(vein) thrombosis
Excludes 1, Do NOT code together
- cor pulmonale without embolism (I27.81)
Excludes 2, Not included here, may code separately
- 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)