2027 ICD-10-CM Diagnosis Code I26.93Single subsegmental thrombotic pulmonary embolism without acute cor pulmonale
ICD-10-CM Codes›I00–I99›I26-I28›I26
- Billable — Valid for Submission
- MCC — Major Complication or Comorbidity
- Risk Adjusts — HCC 267
- Not Chronic
I26.93 is a billable ICD-10-CM diagnosis code for single subsegmental thrombotic pulmonary embolism without acute cor pulmonale. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 173, 175 through 176, 791, 793. As a secondary diagnosis, it counts as a major complication or comorbidity (MCC) and places an inpatient stay in the highest severity level of its MS-DRG family. It does not count, however, when the principal diagnosis is one of 25 closely related codes. Coders also document this condition as isolated subsegmental thrombotic pulmonary embolism. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Acute pulmonary embolism.
For Medicare Advantage risk adjustment, I26.93 maps to CMS-HCC Category 267 (Deep Vein Thrombosis and Pulmonary Embolism) under the V28 model, adding a risk factor of about 0.294 for a community, non-dual, aged beneficiary in payment year 2027.
Code Identity
Code Classification
Medicare Risk Adjustment (HCC)Billing
I26.93 maps to a payment category in the CMS-HCC model used to risk-adjust Medicare Advantage payments. Weights are the published community factors for payment year 2027.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Isolated subsegmental thrombotic pulmonary embolism
- Pulmonary thromboembolism
- Pulmonary thrombosis
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to I26.93: its own notes plus those printed at I26 and Chapter 9. A note printed at a category, block or chapter applies to every code under it.
Includes
Further defines, or gives examples of, the content of the category.
- pulmonary (acute) (artery)(vein) infarction
- pulmonary (acute) (artery)(vein) thromboembolism
- pulmonary (acute) (artery)(vein) thrombosis
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Subsegmental pulmonary embolism NOS
Excludes1
Not coded here: the excluded code is never reported together with this one, unless the two conditions are unrelated.
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
- chronic pulmonary embolism (I27.82)
- personal history of pulmonary embolism (Z86.711)
- pulmonary embolism complicating abortion, ectopic or molar pregnancy (O00-O07, O08.2)
- pulmonary embolism complicating pregnancy, childbirth and the puerperium (O88.-)
- pulmonary embolism due to trauma (T79.0, T79.1)
- pulmonary embolism due to complications of surgical and medical care (T80.0, T81.7-, T82.8-)
- septic (non-pulmonary) arterial embolism (I76)
- certain conditions originating in the perinatal period (P04-P96)
- certain infectious and parasitic diseases (A00-B99)
- complications of pregnancy, childbirth and the puerperium (O00-O9A)
- congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)
- endocrine, nutritional and metabolic diseases (E00-E88)
- injury, poisoning and certain other consequences of external causes (S00-T88)
- neoplasms (C00-D49)
- symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)
- systemic connective tissue disorders (M30-M36)
- transient cerebral ischemic attacks and related syndromes (G45.-)
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Referenced in Other NotesGuidance
Instructional notes printed at other codes that name I26.93, its category, or a range that includes it.
Excludes2 2
These codes carry an Excludes2 note naming I26.93: its condition is not part of those codes, and both may be reported when the patient has both.
Code First 2
These codes say to code first a condition named in the note, and I26.93 is one of the conditions named.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Clinical InformationClinical
Pulmonary Embolism
blocking of the pulmonary artery or one of its branches by an embolus.
Patient EducationClinical
Pulmonary Embolism
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:
The full article covers:
- What is a pulmonary embolism (PE)?
- What causes a pulmonary embolism (PE)?
- Who is more likely to develop a pulmonary embolism (PE)?
- What are the symptoms of a pulmonary embolism (PE)?
- How is a pulmonary embolism (PE) diagnosed?
- What are the treatments for a pulmonary embolism (PE)?
- Can pulmonary embolism (PE) be prevented?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Code History & ChangesHistory
Replacement I26.93 replaces the following previously assigned code(s):
- I26.99 - Other pulmonary embolism without acute cor pulmonale
Questions About I26.93Overview
Is I26.93 (Pulmonary embolism without acute cor pulmonale) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report single subsegmental thrombotic pulmonary embolism without acute cor pulmonale on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does I26.93 group to?
When single subsegmental thrombotic pulmonary embolism without acute cor pulmonale is the principal diagnosis on an inpatient stay, it groups to MS-DRG 793, 791, 175, 176, 173, with relative weights from 0.8061 to 4.2192 depending on complications. Higher weights mean higher Medicare reimbursement.
Is I26.93 a CC or MCC?
CMS lists I26.93 as an MCC (major complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it places the inpatient stay in the highest-weighted DRG of its severity family. It does not count when the principal diagnosis is one of the 25 closely related codes in its exclusion list.
Can I26.93 be reported with I27.81?
Not as a rule. The Excludes1 note at I26, which applies to I26.93, lists "cor pulmonale without embolism (I27.81)". An Excludes1 note means the excluded code is never reported together with this one; the only exception is when the two conditions are unrelated to each other (Official Guidelines, Section I.A.12.a).
What HCC is I26.93?
I26.93 (single subsegmental thrombotic pulmonary embolism without acute cor pulmonale) maps to CMS-HCC Category 267 (Deep Vein Thrombosis and Pulmonary Embolism), commonly written as HCC 267, in the CMS-HCC V28 model used for Medicare Advantage risk adjustment in payment year 2027. It mapped to HCC 107 under the retired V24 model. It also maps in the PACE (CMS-HCC V22), ESRD (V21), and ESRD (V24) models. In the Part D prescription drug model it maps to RxHCC 215.
Does I26.93 risk-adjust for Medicare Advantage payment?
Yes. When documented and reported on a Medicare Advantage encounter, I26.93 adds a risk adjustment factor of about 0.294 to the beneficiary's RAF score for a community, non-dual, aged enrollee (published V28 weights range from 0.245 to 0.568 depending on the payment segment). HCC 267 sits at the top of its hierarchy, so no other condition category supersedes it. See the full factor table on the HCC 267 category page.
