Is I26 a billable ICD-10-CM code?

No. I26 is a non-billable header code. Code to a higher level of specificity using one of its child codes.

Where does I26 sit in the tabular list?

Diseases of the circulatory system (I00-I99), in the block Pulmonary heart disease and diseases of pulmonary circulation (I26-I28).

What cannot be coded together with I26?

I26 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.

I26

I26 — Pulmonary embolism

Non-billable headerICD-10-CM

I26 is a non-billable header ICD-10-CM code for pulmonary embolism. It cannot be billed on its own: choose one of the more specific child codes below.

Excludes1 — never code together

These conditions cannot occur together. Billing both on the same encounter is a denial.

cor pulmonale without embolism (I27.81)

Excludes2 — not included here, but may coexist

The excluded condition is not part of this code, but a patient can have both. You may code both.

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)

Includes

Conditions this code covers.

pulmonary (acute) (artery)(vein) infarction
pulmonary (acute) (artery)(vein) thromboembolism
pulmonary (acute) (artery)(vein) thrombosis

Other codes that can never be billed with I26

These codes carry an Excludes1 note pointing at I26. The conflict binds both ways, but ICD-10-CM only writes it down on one side — so you would not find this by reading I26 alone.

I27.81Cor pulmonale (chronic)

Risk adjustment

I26 does not map to an HCC and does not risk-adjust under CMS-HCC V28. That is normal — most ICD-10 codes do not. It still needs to be coded correctly; it just will not move a RAF score.

Code to one of these instead I26

2 child codes. Green means billable.

Questions about I26

Is I26 a billable ICD-10-CM code?: No. I26 is a non-billable header code. Code to a higher level of specificity using one of its child codes.
Where does I26 sit in the tabular list?: Diseases of the circulatory system (I00-I99), in the block Pulmonary heart disease and diseases of pulmonary circulation (I26-I28).
What cannot be coded together with I26?: I26 carries an Excludes1 note, which means the conditions it lists can never be coded together with it on the same encounter.