Cardiology Coding Alert

ICD-10-CM codes are tricky because there are so many different details you must take into consideration when coding. Septic embolisms are no different. Not only must you know if the embolism is arterial or pulmonary, but you must also know the underlying condition and the location.

Answer these questions to keep your septic embolism coding on the up and up.

Report Septic Arterial Embolisms Like This

Question 1: What is a septic arterial embolism, and which ICD-10-CM code(s) should I report for septic arterial embolisms?

Answer: An arterial septic embolism is a type of blood clot that contains bacteria. The embolism may originate from a central infection, such as in the heart, and then travels through the systemic arterial system to lodge in small vessels anywhere in the body, like the brain, the retina, or the digits.

Report I76 (Septic arterial embolism) for a septic arterial embolism. Per a Code first note, you will need to report the underlying infection first such as infective endocarditis (I33.0) or a lung abscess (J85-). You’ll also need to indicate the location of the embolism with one of the specific four- or five-character codes in the 174.- family (Arterial embolism and thrombosis) such as I74.2 (Embolism and thrombosis of arteries of the upper extremities).

Excludes2: You’ll notice that I74.- codes have an Excludes2 note for I76. “Recall that an Excludes2 note doesn’t mean that you can’t report the codes together; it means that the specific condition is ‘not included here,’” says Melanie Witt, RN, CPC, MA, an independent coding expert based in Guadalupita, New Mexico.

That means the I74.- code doesn’t include the I76 code, but the two conditions may occur together. If the op report indicates the anatomic site of a septic arterial embolism, do this: report both I76 to indicate that this is a septic arterial embolism, and the appropriate I74 code to indicate where the embolism is located.

Identify With or Without Cor Pulmonale for Pulmonary Embolisms

Question 2: What is a septic pulmonary embolism, and how should I report it?

Answer: A septic pulmonary embolus originates from a localized infection such as an area of cellulitis or a central venous catheter infection. The embolic material travels through the venous system to the right side of the heart and moves into the pulmonary arterial system where it lodges in small vessels.

For these cases, you should report either I26.01 (Septic pulmonary embolism with acute cor pulmonale) or I26.90 (Septic pulmonary embolism without acute cor pulmonale).

Don’t miss: As you can see, the descriptor for I26.01 specifies a septic pulmonary embolism “with acute cor pulmonale.” On the other hand, the descriptor for I26.90 is for a septic pulmonary embolism “without acute cor pulmonale.” Cor pulmonale describes a condition involving right-heart failure. Underlying conditions can cause cor pulmonale, such as long-term high blood pressure. The acute form, however, which involves sudden right heart failure, is more likely due to an embolus obstructing the pulmonary artery.

Mind These Sequencing Rules for Embolisms

Question 3: How should I sequence septic embolisms?

Answer 3: Whether reporting septic arterial or pulmonary embolisms, never report these codes as the primary diagnosis.

Instead, the septic embolism codes come with the instructions to “code first the underlying infection.”

Note: Septic embolism codes I26.01, I26.90, and I76 come with the ICD-10-CM instructional note to “code first the underlying infection.”

Example: A patient has a saddle embolus of the abdominal aorta. The underlying infection is acute infective endocarditis. Report the ICD-10-CM codes in this order.

• I33.0 (Acute and subacute infective endocarditis) for the underlying condition, which is the infective endocarditis. This is the primary diagnosis of your claim.
• I76 for the septic arterial embolism. This is the secondary diagnosis of your claim.
• I74.01 (Saddle embolus of abdominal aorta) for the site of the embolism.

Handle Non-Specific Pulmonary Embolism Like This

Question 4: Which ICD-10-CM code should I report if my cardiologist doesn’t identify the specific type of pulmonary embolism?

Answer: If your cardiologist doesn’t identify the specific type of pulmonary embolism, you should report code I26.99 (Other pulmonary embolism without acute cor pulmonale). Code I26.99 also includes the conditions “acute pulmonary embolism NOS” and “pulmonary embolism NOS.”

Focus on These Documentation Details

Question 5: What are some details I must look for in the documentation for septic arterial and/or pulmonary embolisms?

Answer: The documentation must include the type of underlying infection, the diagnosis of the septic embolism itself, and the location of the embolism.