T86.1- Kidney Transplant Codes Do Not Map to a V28 HCC. Contrast Liver, Heart, Lung, and Intestine.

If you searched T86.11, T86.19, Z94.0, or kidney transplant next to V28, you are looking at a transplant cluster where the kidney leaves are billable ICD-10-CM codes and still do not map to a CMS-HCC V28 category for 2026 dates of service.

The T86.1 heading (Complications of kidney transplant) is a nonbillable heading. Its five billable leaves all read No V28 HCC for 2026 dates of service on the live cards: T86.10 unspecified complication, T86.11 rejection, T86.12 failure, T86.13 infection, and T86.19 other complication. Z94.0 (Kidney transplant status) and Z48.22 (Encounter for aftercare following kidney transplant) show the same result. None of those codes has a row in the PY2026 V28 CSV.

That no-map result is the point of this desk. It is not a coding error on the card. Liver, intestine, lung, and heart transplant leaves do map in the same model: liver to HCC 62, intestine to HCC 77, lung to HCC 276, and heart to HCC 221. Kidney differs from those four organs in community V28: none of its T86.1- leaves has a CSV row. Kidney is not the only transplant organ without a complication map, though: the pancreas complication leaves T86.890, T86.891, and T86.899 have no CSV row either (see the brief pancreas contrast below).

As of October 16, 2026, the public ICD leaf cards default to the FY2027 ICD-10-CM edition and read the V28 result from the CMS 2027 Initial ICD-10-CM Mappings (payment year 2027, 2026 dates of service). For every code in this desk, that card result agrees with the PY2026 V28 CSV and the live HCC hubs cited in the contrast table.

This page is the coder-desk walk for kidney transplant codes under CMS-HCC V28. It does not rewrite the T86.41 liver transplant rejection desk, the T86.85- intestine transplant desk, the T86.81- lung transplant desk, the T86.2- heart transplant desk, the status Z codes post, or the CKD coding guide; link those when the organ or the CKD stage is the topic.

Desk table: kidney codes (no V28 map)

Billable does not mean risk-adjusted under community V28. The live cards still show other model lines (for example HHS-HCC 183 on these kidney leaves). This desk is the CMS-HCC V28 Medicare Advantage walk. Do not invent an ESRD-model HCC number for T86.1-, Z94.0, or Z48.22; those cards read No category in the PY2026 CMS mapping on the ESRD line.

Contrast table: solid-organ leaves that do map

CNA refs are the community non-dual aged references on the live hubs. Not member totals. Segment coefficients vary. Full leaf lists and hierarchy walks live on the organ desks linked above.

Pick the T86.1- leaf from the documentation

All five billable leaves have no V28 map. Specificity still matters for the claim and the record:

• T86.11 when the provider documents kidney transplant rejection.
• T86.12 when the provider documents kidney transplant failure.
• T86.13 when the provider documents an infection of the kidney transplant.
• T86.19 when the provider documents another named complication of the kidney transplant.
• T86.10 when a complication of the kidney transplant is documented without more detail.

The FY2027 Official Guidelines (Section I.C.19.g.3.b) say T86.1- is assigned for documented complications of a kidney transplant, such as transplant failure or rejection or another transplant complication. It is not assigned for a post-transplant patient who has chronic kidney disease unless a complication such as failure or rejection is documented. Conditions other than CKD that affect the function of the transplanted kidney get a T86.1- code and a secondary code that identifies the complication. If the documentation is unclear whether the patient has a complication of the transplant, query the provider.

A condition in a transplant recipient is not automatically a transplant complication. When the record suggests a link but the assessment does not state it, a compliant provider query is the fix. See provider query templates.

Do not move a documented kidney transplant complication to a liver, heart, lung, or intestine leaf to create a V28 category. The organ on the record decides the subcategory.

Use additional code: the condition resulting from the complication

The T80-T88 section note is inherited by every T86.1- leaf: use additional code(s) "to identify the specified condition resulting from the complication". The same section also asks for a code for an adverse drug effect, if applicable (T36-T50 with fifth or sixth character 5), and a code for devices involved and details of circumstances (Y62-Y82).

In practice:

1. T86.1- leaf first for the documented kidney transplant complication.

2. Then the specified condition the provider documents as resulting from it. Find that code through the Alphabetic Index and the Tabular. This desk does not pick it for you.

3. Then any adverse effect or device and circumstance codes the notes call for, when they apply.

Sepsis exception. Steps 1 to 3 do not apply as written when sepsis due to infection of the transplanted kidney is the reason for admission. Section I.C.19.g.3.b points to Section I.C.1.d.4 for sequencing of sepsis due to infection in a transplanted organ. That rule has the code(s) for the underlying systemic infection assigned first and the localized infection as a secondary diagnosis when sepsis is the reason for admission. Follow it instead of automatically listing the T86.1- leaf first.

For T86.13, the card also carries code to specify infection. Add the documented organism or infection code the Index supports. Check that companion on its own card for V28 status. The companion may or may not map; the T86.13 leaf itself does not create a V28 HCC.

The T86 category note on every T86.1- card also says to code other transplant complications, such as graft-versus-host disease (D89.81-), malignancy associated with organ transplant (C80.2), and post-transplant lymphoproliferative disorders (PTLD) (D47.Z1). Add those only when the provider documents them. For GVHD, see the D89.81- desk.

Status and aftercare: Z94.0 and Z48.22

Z94.0 (Kidney transplant status) is billable and does not map in community V28. The Z94 category on the card has Excludes1: complications of transplanted organ or tissue - see Alphabetical Index. When the provider documents a kidney transplant complication coded with a T86.1- leaf, do not add Z94.0 for the same transplant. When there is no complication and the provider documents the transplant status, Z94.0 is the status code. See status Z codes that map for the status codes that do carry a V28 HCC, and for why kidney is listed among the ones that do not.

For a kidney transplant patient with CKD but no documented complication, the FY2027 guidelines (Section I.C.14.a.2) say to assign the N18 code for the stage of CKD and Z94.0. The presence of CKD alone does not make a transplant complication. Because the N18 stage code is what carries a V28 category here (N18.5 and N18.6 map to HCC 326), the stage has to be documented; Z94.0 does not supply it.

Z48.22 (Encounter for aftercare following kidney transplant) is billable and does not map. It is an encounter reason for aftercare, not a complication code and not a community V28 HCC source. Do not use it in place of a documented T86.1- leaf when the provider documents a complication, and do not expect it to create a V28 category.

What this means for V28

• Every billable T86.1- leaf, Z94.0, and Z48.22 has no community V28 HCC for 2026 dates of service. Picking T86.11 instead of T86.10 does not create a category.
• Rejection wording alone does not decide the map. Kidney rejection (T86.11) does not map. Liver rejection (T86.41) maps to HCC 62. Heart rejection (T86.21) maps to HCC 221. Lung rejection (T86.810) maps to HCC 276. Intestine rejection (T86.850) maps to HCC 77.
• Report the kidney transplant status or complication when it meets the applicable encounter and coding requirements. A missing V28 map does not by itself remove a reportable diagnosis.
• Do not invent a map from another organ desk. The contrast table is for comparison, not substitution.
• CKD stage 5 / ESRD can map when those codes are documented. N18.5 and N18.6 map to HCC 326 (Chronic Kidney Disease, Stage 5) with a CNA reference of 0.815. That is a CKD-stage map, not a transplant-code map. Use N18.5 or N18.6 only when the provider documents CKD stage 5 or end stage renal disease. Do not add them from a T86.1- or Z94.0 line alone. See the CKD coding guide.
• HCC 326 supersedes HCC 327, 328, and 329 when a mapped stage-5 code is present with a lower CKD category in the same year. Continue reporting each condition that meets the applicable encounter and coding requirements. HCC suppression does not itself remove a reportable diagnosis. In outpatient and office visits, a reportable condition is a current one that coexists at the visit and affects care (Section IV.J), not one documented only as probable, suspected, or another uncertain term (Section IV.H). Inpatient stays follow Section III. Hierarchy changes the score, not the coding. See hierarchy and trumping.

Brief pancreas contrast (optional)

Z94.83 (Pancreas transplant status) is billable and maps to HCC 35 (Pancreas Transplant Status) with a CNA reference of 0.949. The live HCC 35 hub lists 1 ICD-10-CM code. CSV row: `Z9483,35.0,,,`. Hierarchy: HCC 35 supersedes HCC 36, 37, and 38.

Pancreas complication leaves under T86.89x are a different story on the cards we checked: T86.890, T86.891, and T86.899 are billable and show No V28 HCC for 2026 dates of service, with no CSV rows. Status Z94.83 maps; those T86.89x leaves do not. Confirm any other T86.89 leaf on its own card before you claim a map.

MEAT still applies when you report the codes

A missing V28 map does not remove the need for a supported diagnosis when you report T86.1-, Z94.0, or Z48.22. A note that says "history of kidney transplant" with no current assessment does not support a T86.1- leaf by itself.

For a T86.1- code, the note should support:

• M Monitor: graft function, labs, or other findings the provider is following for the transplant complication when documented
• E Evaluate: labs, imaging, biopsy, or exam findings reviewed at the visit, and the provider's link between the finding and the kidney transplant
• A Assess: an explicit complication (rejection, failure, infection, other, or unspecified) of the kidney transplant and its current status
• T Treat: a medication change, a therapy plan, or a documented follow-up plan for the complication

For Z94.0 or Z48.22, the note should show the provider is accounting for the transplant status or aftercare at that visit, not just listing it.

MEAT is a review mnemonic, not a universal CMS coding rule. Follow the applicable coding, encounter, program, and payer requirements. See MEAT, acute vs history of, and problem lists.

Audit and query traps

1. Reporting T86.1 on a claim. It is a nonbillable heading.

2. Expecting T86.11 (or any T86.1- leaf) to map like T86.41, T86.21, T86.810, or T86.850. Kidney does not map in community V28.

3. Expecting Z94.0 to map like Z94.1, Z94.2, Z94.4, or Z94.82. Kidney transplant status has no V28 CSV row.

4. Expecting Z48.22 aftercare to map like Z48.21 or Z48.23. It does not.

5. Adding Z94.0 next to a T86.1- complication code for the same transplant. Z94 Excludes1 complications of transplanted organ or tissue.

6. Moving a documented kidney transplant problem to a liver, heart, lung, or intestine leaf to create RAF.

7. Inventing an ESRD-model HCC number for T86.1-, Z94.0, or Z48.22. Quote the card: no category in the PY2026 CMS mapping on that line.

8. Adding N18.5 or N18.6 from a transplant status line alone. Stage those codes only when CKD stage 5 or ESRD is documented.

9. Skipping the infection-specify or resulting-condition code when the provider documents one, just because the T86.1- leaf does not map.

10. Using any organ-desk CNA reference as a member RAF total.

11. Inventing Coding Clinic quotes, competitor CTAs, or PHI examples.

Two-minute check

1. Did the provider document a kidney transplant status, aftercare encounter, or a complication linked to the kidney transplant?

2. Status without complication: Z94.0. Aftercare encounter: Z48.22. Complication: pick T86.10 / T86.11 / T86.12 / T86.13 / T86.19 from the documentation.

3. No Z94.0 next to a T86.1- complication for the same transplant.

4. Add the resulting-condition or infection-specify code when documented. Check each companion card for V28 status.

5. Expect no community V28 HCC from the kidney transplant codes themselves.

6. If CKD stage 5 or ESRD is separately documented, confirm N18.5 / N18.6 and HCC 326 on their own cards. Do not invent that map from T86.1- or Z94.0.

7. Confirm the no-map result on the live card and the absent CSV row. Confirm MEAT for this year.

Related desks and tools

• Live cards: T86.11, T86.10, T86.12, T86.13, T86.19, T86.1, Z94.0, Z48.22, Z94.83, N18.5, N18.6, T86.41
• Hubs: HCC 35, HCC 62, HCC 77, HCC 221, HCC 276, HCC 326
• Lookup: ICD-10 to HCC, Encoder
• Evidence habits: MEAT, acute vs history of, Excludes1 vs Excludes2, provider query templates, hierarchy and trumping
• Nearby desks: T86.41 liver, T86.85- intestine, T86.81- lung, T86.2- heart, status Z codes that map, CKD coding guide

Sources

• Live HCC Buddy ICD-10-CM cards (FY2027 Tabular display) and the V28 HCC 35, 62, 77, 221, 276, and 326 hubs, fetched October 16, 2026
• FY2027 ICD-10-CM order file billable flags (sha1 `ca62c7ce`)
• PY2026 V28 mapping, hierarchy, and relative factor files on HCC Buddy main
• CMS, ICD-10-CM Official Guidelines for Coding and Reporting, FY 2027 (October 1, 2026 to September 30, 2027), Sections I.C.1.d.4, I.C.14.a.2, I.C.19.g.3.b, III, IV.H, and IV.J
• CMS, ICD-10 codes (FY2027 ICD-10-CM code files, effective October 1, 2026)
• CMS, 2026 Model Software/ICD-10 Mappings (PY2026 V28 mappings, hierarchies, and relative factors)
• CMS, 2027 Model Software/ICD-10 Mappings (2027 Initial ICD-10-CM Mappings, payment year 2027, 2026 dates of service, shown on the live cards)

V28 mappings come from the cited live code pages and the PY2026 V28 CSV. Coefficients are source-labeled references, not member totals. Not medical advice. Not a Coding Clinic reprint.

Current as of October 16, 2026. Always confirm the PY2026 V28 CSV and the live HCC hub before you lock a map claim.