Pulmonary Embolism

The FY2025 updates introduced new codes for coding of pulmonary embolism (PE), a condition where, typically, a blood clot breaks off and lodges in a pulmonary artery. However, not all pulmonary embolisms are caused by blood clots (thrombosis). Embolisms are any foreign matter in a vessel which could include blood clot, air, fat, or a foreign substance. This edition of “In the kNOW” discusses these new codes.

Additions to pulmonary embolism coding include new codes that capture cement and fat embolisms. These additions occur in subcategories I26.0 (PE with acute cor pulmonale) and I26.9 (PE without acute cor pulmonale) as seen below in purple. 

I26.03 Cement embolism of pulmonary artery with acute cor pulmonale
                        Code first complication of other artery following a procedure (T81.718)
I26.04 Fat embolism of pulmonary artery with acute cor pulmonale
                        Code first, if applicable:
                                    complication of other artery following a procedure (T81.718)
                                    traumatic fat embolism (T79.1)
I26.09 Other pulmonary embolism with acute cor pulmonale
                         Acute cor pulmonale NOS
                         Other thrombotic pulmonary embolism with acute cor pulmonale
I26.94 Multiple subsegmental thrombotic pulmonary emboli without acute cor pulmonale
I26.95 Cement embolism of pulmonary artery without acute cor pulmonale
                         Code first complication of other artery following a procedure (T81.718)
I26.96 Fat embolism of pulmonary artery without acute cor pulmonale
                         Code first, if applicable:
                                    complication of other artery following a procedure (T81.718)
                                    traumatic fat embolism (T79.1)
I26.99 Other pulmonary embolism without acute cor pulmonale
                         Acute pulmonary embolism NOS
                         Other thrombotic pulmonary embolism without acute cor pulmonale
                         Pulmonary embolism NOS

The new pulmonary embolism codes identify both cement and fat embolisms. Cement PEs occur as a complication of vertebral kyphoplasty when cement leaks into the pulmonary arteries. The cement used is a fast-setting polymethyl methacrylate (PMMA) setting up a potentially fatal outcome. Fat pulmonary embolisms are an arterial blockage in the lungs due to fat particles rather than a blood clot. This can happen after a bone injury, most commonly a fracture of the pelvis or long bones like the femur, tibia, and fibula. If the fat particles make their way into the circulation, they may create blockages in small vessels. 

The other change to PE coding is the addition of the term “thrombotic” in inclusion terms for codes I26.09 and I26.99, as well as at code I26.94.

Coding professionals should take note of the “Code first” and “Code first, if applicable” notes that accompany the new codes. These direct coders to assign a complication of other artery following a procedure or a traumatic fat embolism first, or first if applicable.

There are already pulmonary embolism codes that identify septic PEs which occur when an infected thrombosis from sources such as an infected tooth, IV drug use, or infective endocarditis leads to a PE after lodging in a pulmonary artery. PE codes also exist for saddle PEs which occur at the bifurcation of the main pulmonary artery thereby blocking both the left and right pulmonary arteries.

Now you are In the kNOW!!

About the Author

Dianna Foley, RHIA, CHPS, CCS, CDIP, has 25 years of HIM experience. She earned her bachelor’s degree from the University of Cincinnati and holds RHIA, CHPS, CDIP, and CCS certifications from AHIMA. Dianna’s an AHIMA-approved ICD-10-CM/PCS trainer, an AHIMA-published author, a participant in AHIMA credential item writing and exam development, and served on the AHIMA Nominating Committee. Dianna has held various HIM positions and is now an independent coding consultant. She previously served as Eastern Gateway Community College’s program director for Medical Coding and HIT. She presents on coding topics at the national, state, and regional levels and serves as OHIMA’s Education Coordinator.