Q26.5
BillableAnomalous portal venous connection
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is Q26.5 an HCC code?
No. Q26.5 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
Q26.5 is the ICD-10-CM diagnosis code for anomalous portal venous connection. A birth defect where the portal vein (which carries blood from the digestive organs to the liver) connects abnormally, disrupting normal blood flow to the liver. Q26.5 sits in the ICD-10-CM chapter for congenital malformations, deformations, chromosomal abnormalities, and genetic disorders (q00-qa0), within the section covering congenital malformations of the circulatory system (q20-q28).
Q26.5 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.
Document the specific type of anomalous connection if available (e.g., portal vein to systemic circulation).
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for Q26.5 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the specific type of anomalous connection if available (e.g., portal vein to systemic circulation)
- •This condition may affect liver function and should be correlated with any documented hepatic complications