I26.90 maps to CMS-HCC V28 267. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupI26.90

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the circulatory system (I00-I99) / Pulmonary heart disease and diseases of pulmonary circulation (I26-I28)

I26.90

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Septic pulmonary embolism without acute cor pulmonale

A blood clot containing bacteria that travels to the lungs, typically from an infection elsewhere in the body, without causing immediate heart failure.

Buddy Insight

Septic pulmonary embolism without acute cor pulmonale represents infected embolic material reaching the pulmonary vasculature without causing right heart failure.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 267

Deep Vein Thrombosis and Pulm...

Coefficient HCC 267: 0.294 (Community Non-Dual Aged (CNA))

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 156

HHS-HCC 156 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 107

Vascular Disease with Complic...

Code-level coefficient reference

RXHCC

Mapped

HCC 215

Venous Thromboembolism

Code-level coefficient reference

Code Book Path

Official

I26Pulmonary embolism I26.9Pulmonary embolism without acute cor pulmonale I26.90Septic pulmonary embolism without acute cor pulmonale

Inclusion Terms

Official

No inclusion terms are included in this display for I26.90. Check the code and parent instructions in the Code Book.

Excludes 2

Official

certain conditions originating in the perinatal period (P04-P96)Inherited from I00-I99, I26
certain infectious and parasitic diseases (A00-B99)Inherited from I00-I99, I26
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from I00-I99, I26
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from I00-I99, I26
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from I00-I99, I26
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from I00-I99, I26
neoplasms (C00-D49)Inherited from I00-I99, I26
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from I00-I99, I26
systemic connective tissue disorders (M30-M36)Inherited from I00-I99, I26
transient cerebral ischemic attacks and related syndromes (G45.-)Inherited from I00-I99, I26
chronic pulmonary embolism (I27.82)Inherited from I00-I99, I26
personal history of pulmonary embolism (Z86.711)Inherited from I00-I99, I26
pulmonary embolism complicating abortion, ectopic or molar pregnancy (O00-O07, O08.2)Inherited from I00-I99, I26
pulmonary embolism complicating pregnancy, childbirth and the puerperium (O88.-)Inherited from I00-I99, I26
pulmonary embolism due to trauma (T79.0, T79.1)Inherited from I00-I99, I26
pulmonary embolism due to complications of surgical and medical care (T80.0, T81.7-, T82.8-)Inherited from I00-I99, I26
septic (non-pulmonary) arterial embolism (I76)Inherited from I00-I99, I26

Related Codes

Official

I26.92Saddle embolus of pulmonary artery without acute cor pulmonale I26.93Single subsegmental thrombotic pulmonary embolism without acute cor pulmonale I26.94Multiple subsegmental thrombotic pulmonary emboli without acute cor pulmonale I26.95Cement embolism of pulmonary artery without acute cor pulmonale I26.96Fat embolism of pulmonary artery without acute cor pulmonale

Includes

Official

pulmonary (acute) (artery)(vein) infarctionInherited from I26
pulmonary (acute) (artery)(vein) thromboembolismInherited from I26
pulmonary (acute) (artery)(vein) thrombosisInherited from I26

Excludes 1

Official

cor pulmonale without embolism (I27.81)Inherited from I26

Code First

Official

underlying infection

Use Additional

Official

No Use Additional Code instructions are included in this display for I26.90. Check the code and parent instructions in the Code Book.

Code Also

Official

No Code Also instructions are included in this display for I26.90. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Imaging evidence of pulmonary embolism

Documentation of infectious/septic etiology of the emboli — source identification (endocarditis, infected catheter, septic thrombophlebitis)

Confirmation that acute cor pulmonale is NOT present — normal right heart function on echocardiography

Blood culture results and antimicrobial sensitivity data

MEAT Support

HCC Buddy guidance

Imaging evidence of pulmonary embolism

Documentation of infectious/septic etiology of the emboli — source identification (endocarditis, infected catheter, septic thrombophlebitis)

Confirmation that acute cor pulmonale is NOT present — normal right heart function on echocardiography

Blood culture results and antimicrobial sensitivity data

Audit Caution

HCC Buddy guidance

Not identifying the septic nature of the emboli and coding as standard thrombotic PE

Missing the transition to acute cor pulmonale as the clinical course progresses — reassess for I26.01 if right heart strain develops

Not coding the underlying infectious source as an additional diagnosis

Confusing septic pulmonary infarcts on imaging with standard thrombotic PE

Common Mistakes

HCC Buddy guidance

I26.01 — Septic pulmonary embolism WITH acute cor pulmonale; same etiology but with right heart failure

I26.99 — Other pulmonary embolism without acute cor pulmonale; non-septic thrombotic PE

J85.1 — Abscess of lung with pneumonia; potential complication of septic emboli

I33.0 — Acute endocarditis; common source of septic emboli

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 →

Is I26.90 an HCC code?

Yes. I26.90 (Septic pulmonary embolism without acute cor pulmonale) maps to HCC 267, Deep Vein Thrombosis and Pulmonary Embolism under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.294. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: I26.90 is billable and maps to V28 HCC 267, Deep Vein Thrombosis and Pulmonary Embolism. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: I26.90
Description: Septic pulmonary embolism without acute cor pulmonale
HCC (V28): HCC 267 — Deep Vein Thrombosis and Pulmonary Embolism
RAF reference coefficient: 0.294
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 267, Deep Vein Thrombosis and Pulmonary Embolism

0.294

ESRDHCC 107, Vascular Disease with Complications

Not separately weighted

RxHCCHCC 215, Venous Thromboembolism

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work I26.90 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for I26.90

For I26.90, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Coder workflow notes

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

I26.90 is the ICD-10-CM diagnosis code for septic pulmonary embolism without acute cor pulmonale. A blood clot containing bacteria that travels to the lungs, typically from an infection elsewhere in the body, without causing immediate heart failure. I26.90 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).

Under the CMS-HCC V28 risk adjustment model, I26.90 maps to Deep Vein Thrombosis and Pulmonary Embolism (HCC 267) with a source-labeled community, non-dual, aged reference coefficient of 0.294. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Verify documentation confirms septic origin; look for concurrent infection codes. For I26.90, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.

HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, and MEAT documentation criteria for I26.90 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Verify documentation confirms septic origin; look for concurrent infection codes
•Ensure acute cor pulmonale is NOT documented; if present, use I26.01 instead

Clinical Significance

Septic pulmonary embolism without acute cor pulmonale represents infected embolic material reaching the pulmonary vasculature without causing right heart failure. While the absence of cor pulmonale suggests a less hemodynamically severe presentation, septic emboli carry significant morbidity due to the infectious component, including risk of lung abscess formation, empyema, and persistent bacteremia. Source control and prolonged antibiotic therapy are essential.

Documentation Requirements

✓Imaging evidence of pulmonary embolism
✓Documentation of infectious/septic etiology of the emboli — source identification (endocarditis, infected catheter, septic thrombophlebitis)
✓Confirmation that acute cor pulmonale is NOT present — normal right heart function on echocardiography
✓Blood culture results and antimicrobial sensitivity data
✓Source control measures and antibiotic treatment plan

Code First

underlying infection

Commonly Confused Codes

•I26.01: Septic pulmonary embolism WITH acute cor pulmonale; same etiology but with right heart failure
•I26.99: Other pulmonary embolism without acute cor pulmonale; non-septic thrombotic PE
•J85.1: Abscess of lung with pneumonia; potential complication of septic emboli
•I33.0: Acute endocarditis; common source of septic emboli