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I26.02 ICD-10-CM Code: Saddle embolus of pulmonary artery with acute cor pulmonale

Compare with another code for I26.02Check this code on a claim

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Official instructions
3 inclusion terms · 1 Excludes1 · 7 Excludes2
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 107 · CMS-HCC V22 category 85 · RxHCC V08 category 186 · RxHCC V08 category 215

What these terms mean →

Billable · FY2027A valid, specific ICD-10-CM code, reportable for dates of service in FY2027.

What you need to know

Source: CMS/NCHS Official ICD-10-CM tabular notes, quoted. From the CMS/NCHS tabular list for the release in force. A note the category or block publishes applies to this code too, and is marked with where it comes from.

Excludes1from I26Not reported with this code unless documented as unrelated
  • cor pulmonale without embolism (I27.81)
Excludes2from I26Not included here; may be reported together
  • 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.-)

+3 more in Instructions

Includesfrom I26What I26 covers
  • pulmonary (acute) (artery)(vein) infarction
  • pulmonary (acute) (artery)(vein) thromboembolism
  • pulmonary (acute) (artery)(vein) thrombosis

Where it sits Source: CMS/NCHS

Under:Chapter 9: Diseases of the Circulatory SystemI26-I28 Pulmonary heart disease and diseases of pulmonary circulationI26 Pulmonary embolismI26.0 Pulmonary embolism with acute cor pulmonale

Most relevant related codes MedCoder-derived

Read off the official notes above and this code’s own position in the tabular list. Which to report is a documentation question; Compare shows the two side by side.

CompareCheck ClaimView Related Codes

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 173 — ULTRASOUND ACCELERATED AND OTHER THROMBOLYSIS WITH PRINCIPAL DIAGNOSIS PULMONARY EMBOLISM (MDC 04)
  • MS-DRG 175 — PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE (MDC 04)
  • MS-DRG 176 — PULMONARY EMBOLISM WITHOUT MCC (MDC 04)
  • MS-DRG 791 — PREMATURITY WITH MAJOR PROBLEMS (MDC 15)
  • MS-DRG 793 — FULL TERM NEONATE WITH MAJOR PROBLEMS (MDC 15)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 267 — Deep Vein Thrombosis and Pulmonary Embolism

Other models: CMS-HCC V22 HCC 107 · CMS-HCC V22 HCC 85 · RxHCC V08 HCC 186 · RxHCC V08 HCC 215

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for I26.02 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on I26.02 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • pulmonary (acute) (artery)(vein) infarction
  • pulmonary (acute) (artery)(vein) thromboembolism
  • pulmonary (acute) (artery)(vein) thrombosis

Source: inherited from I26

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from I26

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from I26

Coder workflow for I26.02

MedCoder structured workflow — derived from this code’s own official record

Before you code I26.02

  1. I26.02’s title joins a condition with an associated condition or complication. Confirm each component is documented. Where the classification presumes the link through the “with” convention, only a provider statement that the conditions are unrelated defeats it. A combination code is assigned only when it fully identifies the documented conditions; a required second code for the stage, type or manifestation is still reported when the notes ask for it (Guidelines I.B.9, I.A.15).

    Guide: Combination codes →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with I26.02. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in I26.02’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewI27.81

Consider I26.02. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).
Acuity
Acute or chronic as documented; when both are documented and separate codes exist, both are reported with the acute code first (Guidelines I.B.8).
The associated condition or complication
Whether the associated condition the title names is documented; the “with” convention presumes some links, and a provider statement that the conditions are unrelated defeats it (Guidelines I.A.15).

Official instructions as workflow

  • Excludes1 — check before selecting I26.02(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with I26.02: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareI27.81

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of I26.02(7 notes)

    Coding workflow: The conditions named in this note are not included in I26.02. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareI27.82, Z86.711, O08.2, O88, T79.0, T79.1

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition I26.02 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewI27.81

Documentation: Only one of the components this code’s title joins is documented.

Coding question: Is I26.02 supported?

Path: Review the code for the documented component on its own.

Reason: A combination code is assigned only when it fully identifies the documented conditions; otherwise the documented component takes its own code (Guidelines I.B.9).

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse I26.02 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of I26.02 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • I27.81— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of cor pulmonale without embolism moves the case to I27.81; the two are not reported together unless documented as unrelated.

    Full comparison: I26.02 vs I27.81 →

  • I27.82— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of chronic pulmonary embolism adds I27.82; it is not part of this code and both may be reported when both are documented.

    Full comparison: I26.02 vs I27.82 →

  • Z86.711— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of personal history of pulmonary embolism adds Z86.711; it is not part of this code and both may be reported when both are documented.

    Full comparison: I26.02 vs Z86.711 →

  • O00— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of pulmonary embolism complicating abortion, ectopic or molar pregnancy adds O00; it is not part of this code and both may be reported when both are documented.

    Full comparison: I26.02 vs O00 →

  • O07— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of pulmonary embolism complicating abortion, ectopic or molar pregnancy adds O07; it is not part of this code and both may be reported when both are documented.

    Full comparison: I26.02 vs O07 →

  • O08.2— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of pulmonary embolism complicating abortion, ectopic or molar pregnancy adds O08.2; it is not part of this code and both may be reported when both are documented.

    Full comparison: I26.02 vs O08.2 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Coding context

Guidelines, coding notes, decision aids, relationships (with MS-DRG and CCSR classification), hierarchy, HCC, coverage and the context map: what a coder reaches for after the core. Each section names whether it is official source data, a MedCoder-derived relationship or MedCoder editorial.

Code Overview

Saddle embolus of pulmonary artery with acute cor pulmonale is a billable ICD-10-CM diagnosis code (I26.02).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Verify Before Coding

  • MCC as a secondary diagnosis (FY2027). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder-derived relationships — computed from published CMS and AHRQ datasets

Other codes that name I26.02 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 1 Excludes1 note: I27.81 — Cor pulmonale (chronic) (via I26.0.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 2 Excludes2 notes: I74 — Arterial embolism and thrombosis (via I26.-), I82 — Other venous embolism and thrombosis (via I26.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 2 Code First instructions across 2 chapters: I5A — Non-ischemic myocardial injury (non-traumatic) (via I26.-), U09.9 — Post COVID-19 condition, unspecified (via I26.-).

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

Referenced by 1 Code Also instruction: I27.24 — Chronic thromboembolic pulmonary hypertension (via I26.-).

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: MCC — Major Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 30 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 5 MS-DRGs: DRG 173 (MDC 04), DRG 175 (MDC 04), DRG 176 (MDC 04), DRG 791 (MDC 15), DRG 793 (MDC 15).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):CIR013 — Acute pulmonary embolism (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as MCC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

I26.04 — Fat embolism of pulmonary artery with acute cor pulmonale, I26.09 — Other pulmonary embolism with acute cor pulmonale, I26.92 — Saddle embolus of pulmonary artery without acute cor pulmonale, I26.93 — Single subsegmental thrombotic pulmonary embolism without acute cor pulmonale, I26.94 — Multiple subsegmental thrombotic pulmonary emboli without acute cor pulmonale, I26.96 — Fat embolism of pulmonary artery without acute cor pulmonale, I26.99 — Other pulmonary embolism without acute cor pulmonale, I27.20 — Pulmonary hypertension, unspecified, I27.21 — Secondary pulmonary arterial hypertension, I27.22 — Pulmonary hypertension due to left heart disease, I27.23 — Pulmonary hypertension due to lung diseases and hypoxia, I27.24 — Chronic thromboembolic pulmonary hypertension, I27.29 — Other secondary pulmonary hypertension, I27.81 — Cor pulmonale (chronic), I27.82 — Chronic pulmonary embolism, I27.83 — Eisenmenger's syndrome, I27.841 — Fontan-associated lymphatic dysfunction, I27.848 — Other Fontan-associated condition, I27.849 — Fontan related circulation, unspecified, I27.89 — Other specified pulmonary heart diseases, +9 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Category (Deep Vein Thrombosis and Pulmonary Embolism) for risk-adjusted payment.

I26.01 — Septic pulmonary embolism with acute cor pulmonale, I26.03 — Cement embolism of pulmonary artery with acute cor pulmonale, I26.04 — Fat embolism of pulmonary artery with acute cor pulmonale, I26.09 — Other pulmonary embolism with acute cor pulmonale, I26.90 — Septic pulmonary embolism without acute cor pulmonale, I26.92 — Saddle embolus of pulmonary artery without acute cor pulmonale, I26.93 — Single subsegmental thrombotic pulmonary embolism without 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, I26.96 — Fat embolism of pulmonary artery without acute cor pulmonale, I26.99 — Other pulmonary embolism without acute cor pulmonale, I27.82 — Chronic pulmonary embolism, I80.10 — Phlebitis and thrombophlebitis of unspecified femoral vein, I80.11 — Phlebitis and thrombophlebitis of right femoral vein, I80.12 — Phlebitis and thrombophlebitis of left femoral vein, I80.13 — Phlebitis and thrombophlebitis of femoral vein, bilateral, I80.201 — Phlebitis and thrombophlebitis of unspecified deep vessels of right lower extremity, I80.202 — Phlebitis and thrombophlebitis of unspecified deep vessels of left lower extremity, I80.203 — Phlebitis and thrombophlebitis of unspecified deep vessels of lower extremities, bilateral, I80.209 — Phlebitis and thrombophlebitis of unspecified deep vessels of unspecified lower extremity, +146 more

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Acute pulmonary embolism).

I26.01 — Septic pulmonary embolism with acute cor pulmonale, I26.04 — Fat embolism of pulmonary artery with acute cor pulmonale, I26.09 — Other pulmonary embolism with acute cor pulmonale, I26.90 — Septic pulmonary embolism without acute cor pulmonale, I26.92 — Saddle embolus of pulmonary artery without acute cor pulmonale, I26.93 — Single subsegmental thrombotic pulmonary embolism without acute cor pulmonale, I26.94 — Multiple subsegmental thrombotic pulmonary emboli without acute cor pulmonale, I26.96 — Fat embolism of pulmonary artery without acute cor pulmonale, I26.99 — Other pulmonary embolism without acute cor pulmonale

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Embolism”, “Saddle”; these codes share that main term but sit in a different category of the Tabular List.

A41.2 — Sepsis due to unspecified staphylococcus (pyemic, staphylococcal), A41.3 — Sepsis due to Hemophilus influenzae (pyemic, Hemophilus influenzae), A41.89 — Other specified sepsis (pyemic, specified organism NEC), A50.57 — Syphilitic saddle nose (nose, due to syphilis), E23.6 — Other disorders of pituitary gland (pituitary), G06.1 — Intraspinal abscess and granuloma (spinal cord, pyogenic origin), G08 — Intracranial and intraspinal phlebitis and thrombophlebitis (venous sinus), G95.19 — Other vascular myelopathies (spinal cord), H34.9 — Unspecified retinal vascular occlusion (eye), I24.0 — Acute coronary thrombosis not resulting in myocardial infarction (artery, coronary, not resulting in infarction), I27.82 — Chronic pulmonary embolism (pulmonary, chronic), I51.3 — Intracardiac thrombosis, not elsewhere classified (heart, not resulting in infarction), I65.1 — Occlusion and stenosis of basilar artery (basilar), I65.8 — Occlusion and stenosis of other precerebral arteries (artery, pontine), I66.3 — Occlusion and stenosis of cerebellar arteries (artery, cerebellar), I66.8 — Occlusion and stenosis of other cerebral arteries (meninges), I67.6 — Nonpyogenic thrombosis of intracranial venous system (intracranial, venous sinus, nonpyogenic), I74.01 — Saddle embolus of abdominal aorta (aorta, aortic, saddle), I74.09 — Other arterial embolism and thrombosis of abdominal aorta (aorta, aortic, abdominal), I74.10 — Embolism and thrombosis of unspecified parts of aorta (aorta, aortic), +95 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of I26.02 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run I26.02 with these 6 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Referenced by Code First instructions

Referenced by Code Also instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • HCC 267 — Deep Vein Thrombosis and Pulmonary Embolism [CMS-HCC]— CMS-HCC V28 · 2026

MS-DRG Grouper

MDC crossing

  • MDC 04 — Diseases and Disorders of the Respiratory System[MDC crossing]: “Diseases and Disorders of the Respiratory System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 4,000 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027
  • MDC 15 — Newborns and Other Neonates with Conditions Originating in Perinatal Period[MDC crossing]: “Newborns and Other Neonates with Conditions Originating in Perinatal Period — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Embolism (multiple) (paradoxical), pulmonary (acute) (artery) (vein), saddle, with acute cor pulmonale[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Embolism (multiple) (paradoxical), saddle, pulmonary artery, with acute cor pulmonale[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Saddle, embolus, pulmonary artery, with acute cor pulmonale[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Nearest codes (14)

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Reference

Index terms and tables, published questions and FAQ, every source behind this page with its release and checksum, the date-of-service check and the complete change history.

Indexed Clinical Terms (3)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Risk adjustment Official source data
2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder-derived relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder editorial explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Current data releases:ICD-10-CM FY2027 · ICD-10-PCS FY2027 · HCPCS October 2026 · MS-DRG v44 · Medicare Code Editor v44.0 · NCCI PTP Q4 2026 · MUE Q4 2026 · NCD code lists 2026-01 · LCD export September 28, 2026 · All releases and sources

Labels on this page: Official source data · MedCoder-derived relationship · MedCoder editorial explanation. How to read the labels · All data sources and release dates · CMS coding rules

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "I26.02 — Saddle embolus of pulmonary artery with acute cor pulmonale." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/i26.02-saddle-embolus-of-pulmonary-artery-with-acute-cor-pulmonale

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Saddle embolus of pulmonary artery with acute cor pulmonale

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to I26.02 in its code family, with their registry titles.

View all codes in the I26 family