2027 ICD-10-CM Diagnosis Code Q26.0Congenital stenosis of vena cava
ICD-10-CM Codes›Q00-Q99›Q20-Q28›Q26
- Billable — Valid for Submission
- CC — Complication or Comorbidity
- POA Exempt
- Chronic Condition
Q26.0 is a billable ICD-10-CM diagnosis code for congenital stenosis of vena cava. It is valid on HIPAA claims for fiscal year 2027 (October 1, 2026 through September 30, 2027) and groups to MS-DRG 306 through 307. As a secondary diagnosis, it counts as a complication or comorbidity (CC) and moves an inpatient stay to a higher severity level within its MS-DRG family. It does not count, however, when the principal diagnosis is one of 9 closely related codes. The code is exempt from POA reporting. Coders also document this condition as abnormality of right superior vena cava. In AHRQ's Clinical Classifications Software (CCSR), this diagnosis falls under Cardiac and circulatory congenital anomalies.
Q26.0 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 191 for payment year 2027.
Code Identity
Code Classification
Present on Admission (POA)Billing
Q26.0 is exempt from POA reporting on inpatient claims to general acute care hospitals. Review the other POA exempt codes in Congenital malformations of the circulatory system (Q20-Q28).
Medicare Risk Adjustment (HCC)Billing
Q26.0 does not risk-adjust for Medicare Advantage under the CMS-HCC V28 model, but it maps to payment categories in the other CMS models shown below.
Source: CMS Payment Year 2027 risk adjustment mappings and model software. Weights are relative factors, not dollar amounts; a beneficiary's total RAF also includes demographics and interactions. Browse all CMS-HCC categories.
Approximate SynonymsGuidance
Alternate terms and clinical phrases that map to this code.
- Abnormality of right superior vena cava
- Congenital stenosis of inferior vena cava
- Congenital stenosis of superior vena cava
- Congenital stenosis of vena cava
- Inferior vena cava stenosis
- Superior vena cava stenosis
Instructional NotesGuidance
Instructions from the official ICD-10-CM Tabular List that apply to Q26.0: its own notes plus those printed at Chapter 17. A note printed at a category, block or chapter applies to every code under it.
Applicable To
Conditions this code is used for: synonyms of the title or, for "other specified" codes, the conditions assigned to it. The list is not exhaustive.
- Congenital stenosis of vena cava (inferior)(superior)
Excludes2
Not included here: the excluded condition is not part of this code, but a patient may have both, so both codes may be reported.
Notes
General instructions on how these codes are used.
- Codes from this chapter are not for use on maternal records
Source: CMS ICD-10-CM Tabular List. How to read instructional notes.
Index to Diseases and InjuriesGuidance
Alphabetical index entries that point to this code.
Malformation (congenital) See Also: Anomaly;
Stenosis, stenotic (cicatricial) See Also: Stricture;
Stricture See Also: Stenosis;
Clinical ClassificationClinical
AHRQ’s CCSR groups this code into broader clinical categories.
Patient EducationClinical
Congenital Heart Defects
Congenital heart defects (CHDs) are problems with the structure of the heart. "Congenital" means that that the problems are present at birth. These defects happen when a fetus's heart doesn't develop normally during pregnancy. Congenital heart defects are the most common type of birth defect.
The full article covers:
- What are congenital heart defects?
- What causes congenital heart defects?
- Who is more likely to have a baby with a congenital heart defect?
- What are the symptoms of congenital heart defects?
- What other problems do congenital heart defects cause?
- How are congenital heart defects diagnosed?
- What are the treatments for congenital heart defects?
Read the full article at MedlinePlus
Courtesy of MedlinePlus, a service of the U.S. National Library of Medicine.
Convert Q26.0 to ICD-9-CMHistory
The closest ICD-9-CM equivalents under the General Equivalence Mappings.
Code HistoryHistory
Questions About Q26.0Overview
What is the ICD-10 code for congenital stenosis of vena cava?
The ICD-10-CM code for congenital stenosis of vena cava is Q26.0 (sometimes written as Q260). It is billable on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
Is Q26.0 (Congenital malformations of great veins) a billable code?
Yes. This is a billable ICD-10-CM code, specific enough to report congenital stenosis of vena cava on HIPAA-covered claims from October 1, 2026 through September 30, 2027.
What MS-DRG does Q26.0 group to?
When congenital stenosis of vena cava is the principal diagnosis on an inpatient stay, it groups to MS-DRG 306, 307, with relative weights from 0.9146 to 1.5457 depending on complications. Higher weights mean higher Medicare reimbursement.
Is Q26.0 a CC or MCC?
CMS lists Q26.0 as a CC (complication or comorbidity) for FY 2027. Reported as a secondary diagnosis, it moves the inpatient stay to a higher-weighted DRG within its severity family. It does not count when the principal diagnosis is one of the 9 closely related codes in its exclusion list.
Is Q26.0 exempt from POA reporting?
Yes. CMS lists this code among those exempt from present on admission reporting, so hospitals do not assign a POA indicator for congenital stenosis of vena cava on inpatient claims. The code appears in the Congenital malformations of the circulatory system (Q20-Q28) range of the CMS exempt list.
Does Q26.0 risk-adjust for Medicare Advantage payment?
Not for Medicare Advantage: Q26.0 maps to no category in the CMS-HCC V28 model. It still risk-adjusts in the RxHCC Part D (V08) category 191 (Ventricular Septal Defect and Major Congenital Heart Disorders).
