ICD-10 I26.90
Billable / Specific HCC v28: 107 MCCSeptic pulmonary embolism without acute cor pulmonale
About ICD-10-CM I26.90
ICD-10-CM code I26.90 represents Septic pulmonary embolism without acute cor pulmonale. This is a billable/specific code in the Circulatory System chapter (block I26). The 2026 edition of ICD-10-CM I26.90 became effective on October 1, 2025.
Coding Tips for I26.90
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
I26.90 is a CMS-HCC v28 risk-adjustment code (category 107). To count for the patient Risk Adjustment Factor (RAF), document the diagnosis with MEAT language each calendar year: Monitored, Evaluated, Assessed, Treated. A diagnosis on the problem list alone does not satisfy CMS RADV audit standards. Include the diagnosis in the assessment with current status and current treatment plan.
I26.90 is designated MCC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-MCC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag MCC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Coding Notes
Code First
- underlying infection
Medicare Advantage HCC Impact
Capture this diagnosis annually for accurate risk adjustment. Missed HCC captures are the #1 revenue leak in Medicare Advantage risk programs.
Inpatient DRG Impact, MCC
codes Septic pulmonary embolism without acute cor pulmonale. As a Major Complication/Comorbidity (MCC), this can shift the DRG assignment to a higher-weighted category, substantial reimbursement impact.
Medicare LCD Coverage for I26.90
Local Coverage Determinations (LCDs) from CMS MACs that list I26.90 as a covered diagnosis.
Showing top 10 of 433 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing I26.90.
5 Medicare
CPT Codes Commonly Billed with I26.90
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
- 93979 CMS LCD: Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies CMS LCD
- 93975 CMS LCD: Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies CMS LCD
- 93976 CMS LCD: Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies CMS LCD
- 93978 CMS LCD: Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies CMS LCD
- 93980 CMS LCD: Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies CMS LCD
- 93981 CMS LCD: Billing and Coding: Non-Invasive Abdominal / Visceral Vascular Studies CMS LCD
- 94618 CMS LCD: Billing and Coding: Pulmonary Stress Testing CMS LCD
- 94619 CMS LCD: Billing and Coding: Pulmonary Stress Testing CMS LCD
- 94617 CMS LCD: Billing and Coding: Pulmonary Stress Testing CMS LCD
- 93990 CMS LCD: Billing and Coding: Non-Invasive Peripheral Venous Vascular and Hemodialysis Access Studies CMS LCD
Convert I26.90 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| I26.90 | 41512 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To I26.90
Other codes in section I26-I28 (Pulmonary heart disease and diseases of pulmonary circulation).
ICD-10 I26.90, Billing FAQ
Is ICD-10 code I26.90 billable? +
Yes, I26.90 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Does I26.90 affect Medicare Advantage HCC risk adjustment? +
Yes. I26.90 maps to CMS-HCC v28 category 107. Capture this diagnosis annually for accurate Medicare Advantage risk score.
Is I26.90 a CC or MCC for inpatient DRG? +
Yes, this code is designated as MCC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What CPT codes are commonly billed with I26.90? +
Procedures frequently paired with I26.90 include: 93979, 93975, 93976, 93978, 93980.
What ICD-9 codes does I26.90 map to? +
Per CMS GEMs, I26.90 maps to ICD-9 codes: 41512. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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