Valid for Submission
I26.01 is a billable diagnosis code used to specify a medical diagnosis of septic pulmonary embolism with acute cor pulmonale. The code I26.01 is valid during the fiscal year 2022 from October 01, 2021 through September 30, 2022 for the submission of HIPAA-covered transactions.
The code I26.01 describes a circumstance which influences the patient's health status but not a current illness or injury. The code is unacceptable as a principal diagnosis.
Tabular List of Diseases and Injuries
The Tabular List of Diseases and Injuries is a list of ICD-10 codes, organized "head to toe" into chapters and sections with coding notes and guidance for inclusions, exclusions, descriptions and more. The following references are applicable to the code I26.01:
Code FirstCode First
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-10-CM has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Wherever such a combination exists, there is a "use additional code" note at the etiology code, and a "code first" note at the manifestation code. These instructional notes indicate the proper sequencing order of the codes, etiology followed by manifestation.
- underlying infection
Index to Diseases and Injuries
The Index to Diseases and Injuries is an alphabetical listing of medical terms, with each term mapped to one or more ICD-10 code(s). The following references for the code I26.01 are found in the index:
The Medicare Code Editor (MCE) detects and reports errors in the coding of claims data. The following ICD-10 Code Edits are applicable to this code:
Diagnostic Related Groups - MS-DRG Mapping
|MS-DRG||MS-DRG Title||MCD||Relative Weight|
|175||PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE||04||1.5442|
|176||PULMONARY EMBOLISM WITHOUT MCC||04||0.8867|
The relative weight of a diagnostic related group determines the reimbursement rate based on the severity of a patient's illness and the associated cost of care during hospitalization.
Convert I26.01 to ICD-9 Code
Information for Patients
What is a pulmonary embolism (PE)?
A pulmonary embolism (PE) is a sudden blockage in a lung artery. It usually happens when a blood clot breaks loose and travels through the bloodstream to the lungs. PE is a serious condition that can cause
- Permanent damage to the lungs
- Low oxygen levels in your blood
- Damage to other organs in your body from not getting enough oxygen
PE can be life-threatening, especially if a clot is large, or if there are many clots.
What causes a pulmonary embolism (PE)?
The cause is usually a blood clot in the leg called a deep vein thrombosis that breaks loose and travels through the bloodstream to the lung.
Who is at risk for a pulmonary embolism (PE)?
Anyone can get a pulmonary embolism (PE), but certain things can raise your risk of PE:
- Having surgery, especially joint replacement surgery
- Certain medical conditions, including
- Heart diseases
- Lung diseases
- A broken hip or leg bone or other trauma
- Hormone-based medicines, such as birth control pills or hormone replacement therapy
- Pregnancy and childbirth. The risk is highest for about six weeks after childbirth.
- Not moving for long periods, such as being on bed rest, having a cast, or taking a long plane flight
- Age. Your risk increases as you get older, especially after age 40.
- Family history and genetics. Certain genetic changes that can increase your risk of blood clots and PE.
What are the symptoms of a pulmonary embolism (PE)?
Half the people who have pulmonary embolism have no symptoms. If you do have symptoms, they can include shortness of breath, chest pain or coughing up blood. Symptoms of a blood clot include warmth, swelling, pain, tenderness and redness of the leg.
How is a pulmonary embolism (PE) diagnosed?
It can be difficult to diagnose PE. To make a diagnosis, your health care provider will
- Take your medical history, including asking about your symptoms and risk factors for PE
- Do a physical exam
- Run some tests, including various imaging tests and possibly some blood tests
What are the treatments for a pulmonary embolism (PE)?
If you have PE, you need medical treatment right away. The goal of treatment is to break up clots and help keep other clots from forming. Treatment options include medicines and procedures.
- Anticoagulants, or blood thinners, keep blood clots from getting larger and stop new clots from forming. You might get them as an injection, a pill, or through an I.V. (intravenous). They can cause bleeding, especially if you are taking other medicines that also thin your blood, such as aspirin.
- Thrombolytics are medicines to dissolve blood clots. You may get them if you have large clots that cause severe symptoms or other serious complications. Thrombolytics can cause sudden bleeding, so they are used if your PE is serious and may be life-threatening.
- Catheter-assisted thrombus removal uses a flexible tube to reach a blood clot in your lung. Your health care provider can insert a tool in the tube to break up the clot or to deliver medicine through the tube. Usually you will get medicine to put you to sleep for this procedure.
- A vena cava filter may be used in some people who cannot take blood thinners. Your health care provider inserts a filter inside a large vein called the vena cava. The filter catches blood clots before they travel to the lungs, which prevents pulmonary embolism. But the filter does not stop new blood clots from forming.
Can pulmonary embolism (PE) be prevented?
Preventing new blood clots can prevent PE. Prevention may include
- Continuing to take blood thinners. It's also important to get regular checkups with your provider, to make sure that the dosage of your medicines is working to prevent blood clots but not causing bleeding.
- Heart-healthy lifestyle changes, such as heart-healthy eating, exercise, and, if you smoke, quitting smoking Using compression stockings to prevent deep vein thrombosis (DVT)
- Moving your legs when sitting for long periods of time (such as on long trips)
- Moving around as soon as possible after surgery or being confined to a bed
NIH: National Heart, Lung, and Blood Institute
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