I26-I28 — Pulmonary heart disease and diseases of pulmonary circulation
ICD-10-CM codes I26-I28 cover pulmonary heart disease and diseases of pulmonary circulation, within diseases of the circulatory system. The block holds 41 codes across 3 categories, of which 33 are billable and 8 are header codes that cannot be submitted on a claim.
Risk adjustment in I26-I28
0 codes in this block map to a CMS-HCC, which means the diagnosis carries a risk-adjustment payment when it is documented and coded. Under-coding here is money left on the table; over-coding here is what audits are for.
- HCC 226 Heart Failure, Except End Stage and Acute
- HCC 267 Deep Vein Thrombosis and Pulmonary Embolism
What else to watch in I26-I28
- 1 codes are laterality-specific. They come in left and right pairs, and the pair is mutually exclusive on a single site: coding both without a bilateral code is a contradiction a scrubber should catch before the payer does.
- 33 codes are named in Medicare coverage policies. An LCD or NCD lists them as supporting medical necessity, or explicitly as not supporting it. Which applies depends on the MAC for your state.