ICD-10 Code for History of Pulmonary Embolism
For documenting a past (resolved) pulmonary embolism, use ICD-10-CM code Z86.711 (Personal history of pulmonary embolism).
Code Selection and Documentation
The appropriate code depends on the clinical context:
Z86.711: Use this code when documenting a resolved PE as part of the patient's medical history. This is the correct code when PE is not currently active but is relevant to the patient's care (e.g., for anticoagulation decisions, risk stratification for future procedures, or explaining current symptoms).
I26.0 or I26.9: These codes are reserved for acute, active pulmonary embolism during the current encounter. I26.0 indicates PE with acute cor pulmonale, while I26.9 is PE without mention of acute cor pulmonale.
Critical Coding Considerations
Accuracy of PE ICD-10 Codes
When reviewing medical records or conducting research, be aware that ICD-10 codes for PE have significant limitations:
- Principal discharge codes alone miss approximately 40% of acute PEs (sensitivity 58.3%) 1
- Combining principal and secondary discharge codes with PE imaging codes achieves the best accuracy (sensitivity 81.6%, positive predictive value 84.7%) 1
- False positive rates can reach 17.7%, often due to ambiguous documentation like "rule out PE" being incorrectly coded as confirmed PE 2
- Subsegmental PE codes are particularly unreliable with sensitivity of only 7.0% 3
Documentation Best Practices
To ensure accurate coding:
- Be explicit in your documentation: Write "history of pulmonary embolism" or "resolved pulmonary embolism" rather than ambiguous phrases
- Avoid vague language: Terms like "rule out PE" or "query PE" frequently lead to coding errors 2
- Specify timing: Clearly indicate whether the PE is acute/current versus historical
- Include relevant details: Document the date of the prior PE, treatment received, and current anticoagulation status when applicable
Clinical Context
The distinction between active and historical PE is clinically crucial because:
- Treatment implications: Active PE requires immediate anticoagulation and risk stratification 4, 5, while history of PE influences decisions about prophylaxis, duration of anticoagulation, and perioperative management
- Risk assessment: Patients with prior PE have increased risk of recurrence, affecting clinical decision-making
- Quality metrics: Healthcare systems track acute PE rates; incorrect coding of historical PE as acute can distort quality measures
When documenting for billing or research purposes, Z86.711 is the definitive code for resolved PE that remains clinically relevant to the patient's current care.