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ICD-10-CM I26.96: Fat embolism of pulmonary artery without acute cor pulmonale

I26.96 is the billable ICD-10-CM code for fat embolism of pulmonary artery without acute cor pulmonale, in category I26 (Pulmonary embolism) of the Pulmonary heart disease and diseases of pulmonary circulation section. As a principal diagnosis it groups to MS-DRG 173 Ultrasound Accelerated and Other Thrombolysis with Principal Diagnosis Pulmonary Embolism, MS-DRG 175 Pulmonary Embolism with MCC or Acute Cor Pulmonale, MS-DRG 176 Pulmonary Embolism without MCC (MDC 04 MDC 04: Diseases and Disorders of the Respiratory System); or MS-DRG 791 Prematurity with Major Problems, MS-DRG 793 Full Term Neonate with Major Problems (MDC 15 MDC 15: Newborns and Other Neonates with Conditions Originating in Perinatal Period). It maps to HCC 267 (Deep Vein Thrombosis and Pulmonary Embolism) in CMS-HCC V28. As a secondary diagnosis it is an MCC, excluded with 25 principal diagnoses. 21 LCD billing and coding articles list it as covered.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM code descriptions: FY2027 (effective October 1, 2026); IPPS Table 5 (MS-DRG weights): v44 FY2027 (final rule + CN3) (effective October 1, 2026); ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); Medicare Coverage Database billing and coding articles: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: FY2028 code files, effective October 1, 2027 for the ICD-10-CM code descriptions; FY2028 final rule (August 2027), effective October 1, 2027; an April 1 interim grouper update when CMS issues one for the IPPS Table 5 (MS-DRG weights); PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027) for the ICD-10-CM to HCC mapping; weekly, every Thursday for the Medicare Coverage Database billing and coding articles.

Code
I26.96
billable FY2027 ICD-10-CM code
Category
I26 Pulmonary embolism
Chapter
9: Diseases of the circulatory system (I00-I99)
CC/MCC (MS-DRG v44)
MCC
CMS-HCC V28
HCC 267
POA reporting
Required

Tabular list notes for I26.96

The tabular list has no notes on I26.96 itself; the notes below apply from its parent headings.

Inherited from I26 (Pulmonary embolism)

Includes
  • pulmonary (acute) (artery)(vein) infarction
  • pulmonary (acute) (artery)(vein) thromboembolism
  • pulmonary (acute) (artery)(vein) thrombosis
Excludes1 (never coded together)
  • cor pulmonale without embolism (I27.81)
Excludes2 (not part of this condition, may be coded 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.-)
  • pulmonary embolism due to trauma (T79.0, T79.1)
  • pulmonary embolism due to complications of surgical and medical care (T80.0, T81.7-, T82.8-)
  • septic (non-pulmonary) arterial embolism (I76)

MS-DRG grouping when I26.96 is the principal diagnosis

MS-DRG v44 groups for I26.96 as principal diagnosis
MDCMS-DRGs
04 MDC 04: Diseases and Disorders of the Respiratory System173175176
15 MDC 15: Newborns and Other Neonates with Conditions Originating in Perinatal Period791793

The final group also depends on procedures, secondary diagnoses and discharge status; the MS-DRG lookup for I26.96 shows the full grouping logic.

CC/MCC status and inpatient edits

As a secondary diagnosis, I26.96 is an MCC under MS-DRG v44, unless the principal diagnosis is one of the 25 codes in its exclusion list. Check I26.96 against a principal diagnosis.

  • Present on admission: a POA indicator is required on inpatient claims.
  • Hospital-acquired condition: HAC 10 Deep Vein Thrombosis (DVT) / Pulmonary Embolism (PE) with Total Knee or Hip Replacement.

CMS-HCC V28 risk adjustment

In the PY2027 mapping, I26.96 maps to HCC 267 (Deep Vein Thrombosis and Pulmonary Embolism). The HCC lookup shows the RAF weight and the hierarchy.

LCD billing and coding articles that list I26.96

21 current Medicare billing and coding articles list I26.96 among the diagnoses that support medical necessity for the services they cover.

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Frequently asked questions

What does ICD-10-CM I26.96 mean?

I26.96 means fat embolism of pulmonary artery without acute cor pulmonale. It is one of 12 billable codes under I26, pulmonary embolism.

Which MS-DRG does I26.96 group to?

As the principal diagnosis, I26.96 groups to MS-DRG 173 Ultrasound Accelerated and Other Thrombolysis with Principal Diagnosis Pulmonary Embolism, MS-DRG 175 Pulmonary Embolism with MCC or Acute Cor Pulmonale, MS-DRG 176 Pulmonary Embolism without MCC (MDC 04 MDC 04: Diseases and Disorders of the Respiratory System); or MS-DRG 791 Prematurity with Major Problems, MS-DRG 793 Full Term Neonate with Major Problems (MDC 15 MDC 15: Newborns and Other Neonates with Conditions Originating in Perinatal Period) under MS-DRG v44, before procedures and secondary diagnoses are applied.

Does I26.96 map to an HCC?

Yes: HCC 267, Deep Vein Thrombosis and Pulmonary Embolism, in the PY2027 CMS-HCC V28 mapping.

Is I26.96 a CC or MCC?

I26.96 is an MCC under MS-DRG v44; 25 principal diagnoses exclude it.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

The descriptor and notes are reproduced from the FY2027 ICD-10-CM files; MS-DRG, CC/MCC and HCC facts come from the CMS FY2027 and PY2027 tables. Code from the medical record and the ICD-10-CM Official Guidelines. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.