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v1.0.0
ICD-10 Guide
ICD-10 CodesQ26.9

Q26.9

Billable

Congenital malformation of great vein, unspecified

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 Q26.9 is a billable code used to indicate a diagnosis of congenital malformation of great vein, unspecified.

Key Diagnostic Point:

Congenital malformations of the great veins can lead to significant hemodynamic alterations and clinical manifestations in affected individuals. These malformations may include anomalies such as agenesis, hypoplasia, or abnormal connections of the great veins, which can disrupt normal blood flow and oxygenation. The great veins, including the superior and inferior vena cavae, are crucial for returning deoxygenated blood to the heart. When these structures are malformed, patients may present with symptoms such as cyanosis, heart failure, or respiratory distress, particularly in neonates. Diagnosis typically involves imaging studies such as echocardiography, MRI, or CT scans to visualize the vascular structures and assess the severity of the malformation. Management may require surgical intervention, particularly in severe cases, to correct the anatomical defects and restore normal hemodynamics. The prognosis varies widely depending on the specific nature of the malformation and the presence of associated congenital heart defects.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in presentation and severity of malformations
  • Need for detailed imaging and diagnostic documentation
  • Potential for associated congenital heart defects complicating coding
  • Differentiation from other vascular anomalies

Audit Risk Factors

  • Inadequate documentation of the specific malformation
  • Failure to document associated congenital heart defects
  • Misclassification of the malformation type
  • Lack of clarity in imaging reports

Specialty Focus

Medical Specialties

Pediatrics

Documentation Requirements

Pediatric documentation must include growth parameters, developmental milestones, and specific symptoms related to the congenital malformation.

Common Clinical Scenarios

Common scenarios include a newborn presenting with cyanosis or respiratory distress due to a great vein anomaly, requiring immediate evaluation and potential intervention.

Billing Considerations

Accurate coding requires a comprehensive understanding of the patient's clinical presentation and any associated congenital heart defects.

Genetics

Documentation Requirements

Genetic documentation should include family history, genetic testing results, and any syndromic associations with the congenital malformation.

Common Clinical Scenarios

Scenarios may involve genetic counseling for families with a history of congenital heart defects or chromosomal abnormalities.

Billing Considerations

Consideration of syndromic associations is crucial, as many congenital malformations may be part of broader genetic syndromes.

Coding Guidelines

Inclusion Criteria

Use Q26.9 When
  • Follow official coding guidelines for congenital conditions, ensuring accurate documentation of the malformation type, associated conditions, and any interventions performed
  • Use additional codes as necessary to capture the full clinical picture

Exclusion Criteria

Do NOT use Q26.9 When
No specific exclusions found.

Related ICD-10 Codes

Related CPT Codes

93306CPT Code

Echocardiography, transthoracic, real-time with interpretation and report

Clinical Scenario

Used for initial evaluation of congenital heart defects and associated great vein malformations.

Documentation Requirements

Complete echocardiographic report detailing findings related to great vein anomalies.

Specialty Considerations

Pediatric cardiology may require additional imaging studies for comprehensive assessment.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the accuracy of data collection and reimbursement processes. Q26.9 provides a clear designation for unspecified great vein malformations, facilitating better tracking and management of these conditions.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of congenital malformations, improving the accuracy of data collection and reimbursement processes. Q26.9 provides a clear designation for unspecified great vein malformations, facilitating better tracking and management of these conditions.

Reimbursement & Billing Impact

reimbursement processes. Q26.9 provides a clear designation for unspecified great vein malformations, facilitating better tracking and management of these conditions.

Resources

Clinical References

  • •
    American Academy of Pediatrics - Coding for Congenital Heart Disease

Coding & Billing References

  • •
    American Academy of Pediatrics - Coding for Congenital Heart Disease

Frequently Asked Questions

What are the common symptoms associated with congenital malformations of the great veins?

Common symptoms include cyanosis, respiratory distress, and signs of heart failure, particularly in neonates. These symptoms arise due to impaired blood flow and oxygenation resulting from the malformation.