I26.02

HCC Category Mapping

What This Code Means

A life-threatening emergency where a large blood clot straddles the pulmonary artery bifurcation, causing acute heart failure on the right side.

Coding Tips

• •A saddle embolus is a specific anatomical location; confirm imaging documentation describes this configuration
• •This represents a massive pulmonary embolism; ensure acute cor pulmonale is documented as a consequence

Clinical Significance

A saddle embolus of the pulmonary artery with acute cor pulmonale represents a large thrombus straddling the bifurcation of the main pulmonary artery, causing massive obstruction to pulmonary blood flow and acute right heart failure. This is among the most hemodynamically significant forms of pulmonary embolism, with high mortality rates. It often presents with cardiovascular collapse and may require emergent surgical embolectomy, catheter-directed therapy, or systemic thrombolysis.

Documentation Requirements

• ✓CT pulmonary angiography confirming saddle embolus at the main pulmonary artery bifurcation
• ✓Evidence of acute cor pulmonale — right ventricular dilation, elevated right heart pressures, septal bowing, or troponin elevation
• ✓Hemodynamic status documentation including blood pressure, heart rate, and evidence of shock if present
• ✓Emergent treatment plan including anticoagulation, thrombolysis, or surgical intervention
• ✓Risk stratification using validated scoring systems (PESI, sPESI)

Commonly Confused Codes