ICD 10 Coding Alert

Important: Don’t report a septic embolism as a primary condition.

Understanding what diagnosis details to look for is crucial to reporting septic embolisms correctly. For example, to report a septic embolism, you need to know whether the provider has diagnosed an arterial embolism or a pulmonary embolism, as well as any underlying infection and all proper sequencing rules.

Use these questions and answers to guide your way to clean septic embolism claims.

Define Septic Arterial Embolism

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.

Look to 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 Embolism

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.

Use These Codes to Report 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.”

Report I26.99 in These Circumstances

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

Answer 5: If your provider 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.”

Follow 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.”

Try Coding This Septic Pulmonary Embolism Scenario

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.

Follow Guidelines to Solve This Sequencing Question

Question 8: My provider 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.