Cardiology Coding Alert

Remember: Never report septic embolism as the primary diagnosis.

Reporting septic embolisms can be tricky because you must know if your cardiologist has diagnosed an arterial embolism or a pulmonary embolism. You must also know the underlying infection, as well as the proper sequencing rules.

Answer these questions to always submit clean septic embolism claims in your practice.

First, Define Septic Arterial Embolism for Clarity

Question 1: What is a septic arterial embolism?

Answer 1: A septic arterial embolus may originate from a central infection, such as in the heart and then travel through the systemic arterial system to lodge in small vessels anywhere in the body, such as the brain, the retina, or the digits.

Report I76 for Septic Arterial Embolisms

Question 2: Which ICD-10-CM code should I report for septic arterial embolisms?

Answer 2: You should report code I76 (Septic arterial embolism) for a septic arterial embolism.

“Be sure to code the underlying infection first, such as infective endocarditis, a lung abscess, or an infection from an indwelling vascular catheter or graft,” says Robin Peterson, CPC, CPMA, Manager of Professional Coding, Pinnacle Integrated Coding Solutions, LLC. “You’ll also want to code the site of the embolism with I74.- (Arterial embolism and thrombosis) through I74.9 (Embolism and thrombosis of unspecified artery).”

Understand Septic Pulmonary Embolisms

Question 3: What is a septic pulmonary embolism?

Answer 3: A septic pulmonary embolus originates from a localized infection such as a localized 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.

Rely on These ICD-10-CM Codes for Septic Pulmonary Embolisms

Question 4: Which ICD-10-CM codes should I report for septic pulmonary embolisms?

Answer 4: For septic pulmonary embolisms, you should report either code I26.01 (Septic pulmonary embolism with acute cor pulmonale) or code I26.90 (Septic pulmonary embolism without acute cor pulmonale).

Don’t miss: As you can see, the code 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.

Know When to Report I26.99

Question 5: Which ICD-10-CM code should I report if my cardiologist doesn’t identify the specific type of pulmonary embolism?

Answer 5: 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.”

Delve Into Sequencing Rules

Question 6: How should I sequence septic embolisms?

Answer 6: Whether reporting septic arterial or pulmonary embolisms, you should never report these codes as the primary diagnosis. Instead, septic embolism codes come with the instructions to “code first the underlying infection.”

Decode This Septic Pulmonary Embolism Example

Question 7: The hospital admitted a 67-year-old chain smoker with fever, shortness of breath, and pulmonary infiltrates, one of which has a small cavity in it. Staphylococcus aureus is cultured from the blood, and the pulmonologist diagnoses tricuspid endocarditis. How should I report this scenario?

Answer 7: You should code A41.01 (Sepsis due to Methicillin susceptible Staphylococcus aureus) for the staphylococcal septicemia, I33.0 (Acute and subacute infective endocarditis) for acute bacterial endocarditis, and I26.90 for septic pulmonary emboli. The example tells you that before I26.90, you should also bill for another code identifying the septicemia (A41.0-A41.9, Other sepsis). You should also report B95.61 (Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere) for the infectious organism of the bacterial endocarditis.

Solve Septic Arterial Embolism Conundrum

Question 8: My cardiologist diagnosed the patient with a saddle embolus of the abdominal aorta. The underlying infection is acute infective endocarditis. Which ICD-10-CM codes should I report?

Answer 8: You should report I33.0 (Acute and subacute infective endocarditis) as the primary diagnosis and I76 (Septic arterial embolism) as the secondary diagnosis. You should also report I74.01 (Saddle embolus of abdominal aorta) to identify the site of the embolism.