I26.03

Billable

Cement embolism of pulmonary artery with acute cor pulmonale

HCC Category Mapping

V28HCC 267 — Vascular Disease

0.356

What This Code Means

A rare but serious emergency where cement material used in orthopedic surgery travels to the lungs and causes acute heart failure.

Coding Tips

•This code requires documentation of a recent orthopedic procedure (typically joint replacement) and confirmation of cement embolism
•Document the source procedure and timing to establish the causal relationship

Clinical Significance

Cement embolism with acute cor pulmonale is an iatrogenic complication occurring during vertebroplasty or kyphoplasty procedures, where polymethylmethacrylate bone cement migrates into the venous system and embolizes to the pulmonary vasculature. The acute cor pulmonale indicates significant right heart strain from the cement embolic burden. This is a recognized procedural complication that can be immediately life-threatening and requires emergent management.

Documentation Requirements

✓Recent history of vertebroplasty, kyphoplasty, or other cement-utilizing orthopedic procedure
✓Imaging evidence of cement material in the pulmonary vasculature (CT showing hyperdense material)
✓Evidence of acute cor pulmonale — right heart strain on echocardiography or clinical signs
✓Temporal relationship between the procedure and symptom onset
✓Treatment plan and any consideration of cement retrieval if feasible

Code First

complication of other artery following a procedure (T81.718)

Commonly Confused Codes

I26.95 — Cement embolism of pulmonary artery without acute cor pulmonale; same etiology but no right heart failure I26.09 — Other pulmonary embolism with acute cor pulmonale; non-cement embolic material I26.04 — Fat embolism with acute cor pulmonale; fat emboli, different mechanism T81.718A — Complication of bone cement; external cause code for the cement complication

Code Hierarchy

└I26Pulmonary embolism └I26.0Pulmonary embolism with acute cor pulmonale └I26.03Cement embolism of pulmonary artery with acute cor pulmonale

└I26.03Cement embolism of pulmonary artery with acute cor pulmonale