Saddle embolus of pulmonary artery with acute cor pulmonale

This diagnosis code signifies a severe form of pulmonary embolism where a large clot straddles the bifurcation of the main pulmonary artery, obstructing blood flow to both lungs. This massive obstruction leads to acute right heart failure, known as acute cor pulmonale, due to the sudden increase in pulmonary vascular resistance. It represents a life-threatening medical emergency.

Apply this code when documentation explicitly states a saddle embolus of the pulmonary artery and also confirms the presence of acute cor pulmonale. This typically occurs in patients presenting with sudden onset dyspnea, chest pain, syncope, and signs of right ventricular strain on ECG or echocardiogram. Diagnostic imaging, such as CT pulmonary angiography, will confirm the saddle embolus.

• Ensure documentation clearly links the acute cor pulmonale to the saddle embolus; do not assume causation.
• Distinguish from other forms of pulmonary embolism without acute cor pulmonale (I26.01) or without mention of cor pulmonale (I26.9x).
• Always sequence this code as the principal diagnosis when it is the primary reason for the encounter.