ICD-10 · PDGM grouping
I26 Pulmonary embolism
All 12 codes in the I26 family, with the PDGM clinical group, comorbidity subgroup and primary-position rule CMS assigns, read from the CMS grouper crosswalk v07.2.26 and the CDC FY2027 code file.
Codes in family
12
Can lead a claim
8
Cannot lead a claim
4
What CMS assigns to I26
8 of the 12 codes group to MMTA - Cardiac and Circulatory; 4 are assigned no clinical group. 8 of the 12 count toward the Other Venous Embolism and Thrombosis comorbidity subgroup; 4 are assigned none. 8 of the 12 can lead a claim. CMS attaches a code-first note to 6 of the 12.
- Other Venous Embolism and Thrombosis: can award the low comorbidity tier as a secondary diagnosis.
Code first
CMS grouper convention 12, on I26.01, I26.90. Code first:
- underlying disease
CMS grouper convention 64, on I26.03, I26.95. Code first:
- complication of other artery following a procedure (T81.718)
CMS grouper convention 65, on I26.04, I26.96. Code first:
- , if applicable:
- complication of other artery following a procedure (T81.718)
- traumatic fat embolism (T79.1)
Every code in I26
Descriptions are CDC’s FY2027 wording; where CMS’s grouper abbreviates one, its form is shown beneath.
| Code | Description | Primary position | Clinical group | Comorbidity subgroup |
|---|---|---|---|---|
| I26.0 Pulmonary embolism with acute cor pulmonale | ||||
| I26.01 | Septic pulmonary embolism with acute cor pulmonale | Cannot lead a claimUnacceptable principal diagnosis, code is not reportable as principal diagnosis | None | None |
| I26.02 | Saddle embolus of pulmonary artery with acute cor pulmonale | Can lead a claim | H | None |
| I26.03 | Cement embolism of pulmonary artery with acute cor pulmonale | Cannot lead a claimUnacceptable principal diagnosis, code is not reportable as principal diagnosis | None | Other Venous Embolism and Thrombosis |
| I26.04 | Fat embolism of pulmonary artery with acute cor pulmonale | Can lead a claim, code first applies | H | Other Venous Embolism and Thrombosis |
| I26.09 | Other pulmonary embolism with acute cor pulmonale | Can lead a claim | H | Other Venous Embolism and Thrombosis |
| I26.9 Pulmonary embolism without acute cor pulmonale | ||||
| I26.90 | Septic pulmonary embolism without acute cor pulmonale | Cannot lead a claimUnacceptable principal diagnosis, code is not reportable as principal diagnosis | None | None |
| I26.92 | Saddle embolus of pulmonary artery without acute cor pulmonaleCMS: Saddle embolus of pulmonary artery w/o acute cor pulmonale | Can lead a claim | H | None |
| I26.93 | Single subsegmental thrombotic pulmonary embolism without acute cor pulmonaleCMS: Sing subsegmental throm pulm emblsm w/o acute cor pulmonale | Can lead a claim | H | Other Venous Embolism and Thrombosis |
| I26.94 | Multiple subsegmental thrombotic pulmonary emboli without acute cor pulmonaleCMS: Mult subsegmental throm pulm emboli w/o acute cor pulmonale | Can lead a claim | H | Other Venous Embolism and Thrombosis |
| I26.95 | Cement embolism of pulmonary artery without acute cor pulmonaleCMS: Cement embolism of pulm artery without acute cor pulmonale | Cannot lead a claimUnacceptable principal diagnosis, code is not reportable as principal diagnosis | None | Other Venous Embolism and Thrombosis |
| I26.96 | Fat embolism of pulmonary artery without acute cor pulmonale | Can lead a claim, code first applies | H | Other Venous Embolism and Thrombosis |
| I26.99 | Other pulmonary embolism without acute cor pulmonale | Can lead a claim | H | Other Venous Embolism and Thrombosis |
Sources: CMS HH PPS Grouper Software v07.2.26, effective 2026-10-01, for the clinical group, comorbidity subgroup, code-first conventions and primary-position flags; CDC NCHS ICD-10-CM FY2027 code descriptions for the family title and code wording. This is the crosswalk Medicare runs a claim through. Grouping also depends on admission source, timing, the OASIS functional items and the rest of the diagnosis list.
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