I26.09
BillableOther pulmonary embolism with acute cor pulmonale
HCC Category Mapping
V28HCC 267 — Vascular Disease
0.356What This Code Means
A blood clot that travels to the lungs and causes the right side of the heart to fail acutely, resulting in a life-threatening condition.
Coding Tips
- •This code indicates acute cor pulmonale is present; do not use if cor pulmonale is absent
- •Document the source of embolism when possible to support medical necessity and severity
Clinical Significance
This code captures pulmonary embolism with acute cor pulmonale that is not classified as septic, saddle, cement, or fat embolism. This most commonly represents standard thrombotic pulmonary embolism with right heart failure, which is the most frequent form of clinically significant PE. Acute cor pulmonale indicates hemodynamically significant embolic burden causing right ventricular strain and is associated with increased mortality risk.
Documentation Requirements
- ✓Imaging confirmation of pulmonary embolism (CT pulmonary angiography or V/Q scan)
- ✓Evidence of acute cor pulmonale — right ventricular dilation/dysfunction, elevated troponin, BNP elevation, or clinical signs of right heart failure
- ✓Hemodynamic assessment including blood pressure, heart rate, and oxygen saturation
- ✓Risk stratification (massive vs submassive vs low risk PE)
- ✓Treatment plan including anticoagulation, thrombolysis consideration, or interventional options
Commonly Confused Codes
I26.02 — Saddle embolus with acute cor pulmonale; specific anatomic location at bifurcationI26.01 — Septic pulmonary embolism with acute cor pulmonale; infectious originI26.90-I26.99 — Pulmonary embolism WITHOUT acute cor pulmonale; no right heart failureI27.82 — Chronic pulmonary embolism; long-standing/recurrent PE rather than acute
Code Hierarchy
└I26Pulmonary embolism└I26.0Pulmonary embolism with acute cor pulmonale└I26.09Other pulmonary embolism with acute cor pulmonale
└I26.09Other pulmonary embolism with acute cor pulmonale