A pulmonary embolism (PE) is a clot that has become lodged in the lung, and often occurs when a patient has a deep vein thrombosis that dislodges and travels to the pulmonary vessels. A PE will block the pulmonary arteries resulting in reduced blood flow to the associated lung areas.
In ICD-10-CM, coding for pulmonary embolisms requires that we determine if the embolism is segmental or subsegmental. Segmental PEs occur in the initial arterial divisions off the pulmonary trunk. Subsegmental PEs occur in further branches of the arteries. These subsegmental PEs have come to light with advancements in imaging technology. Many patients with subsegmental PEs are asymptomatic, with periodic surveillance replacing the use of long-term anticoagulants as the standard of care. While capturing the coding distinction between segmental and subsegmental PEs, the distinct codes permit tracking of treatment efficacy, and provide clarity for research.
Another type of PE is called a saddle PE. Exactly as its name suggest, a saddle PE is one that straddles the bifurcation of the main pulmonary artery into the right and left main pulmonary arteries.
One other factor that must be considered when coding for pulmonary embolisms is whether or not acute cor pulmonale is present. Acute cor pulmonale is a structural and functional disorder of the right ventricle which is caused by a primary respiratory disorder. Symptoms include elevated right heart pressures which can lead to right heart failure. Coding professionals should be reading the chest CT reports to see if there is any mention of severe/significant right heart strain or dysfunction. Should this be found, without mention of acute cor pulmonale, then a query may be in order.
Patients who suffer from a massive pulmonary embolism are at risk for acute cor pulmonale. There are combination codes available when acute cor pulmonale is present with a pulmonary embolism. In category I26.0, the acute cor pulmonale is identified with a PE which is either septic, saddle, or other. Notice there is no code for subsegmental PE with acute cor pulmonale.
An important coding consideration to be aware of is that if the pulmonary embolism is the principal diagnosis and there are no MCCs for the account, if the PE is with acute cor pulmonale, then that acts as the MCC. That will take the DRG from 176 with a relative weight of 0.8878 to DRG 175 with a relative weight of 1.5460.
Now you are In the kNOW!!
About the Author
Dianna Foley, RHIA, CHPS, CCS, CDIP is
OHIMA's Coding Education Coordinator. Dianna has been an HIM
professional for 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.
