Condition guide
Organ Transplant Status HCC Coding Guide
Organ Transplant Status (e.g. Z94.1) maps to HCC 221 (Heart Transplant Status/Complications) under CMS-HCC V28. Its source-labeled community non-dual aged reference coefficient is 1.053. This is not a member total; full contribution depends on hierarchy, cleanup, interactions, member context, and model year. Z94.0, kidney transplant status, is non-HCC under V28. It can also map to HCC 276 (Lung Transplant Status/Complications) and HCC 35 (Pancreas Transplant Status) when the documentation supports those manifestations.
Quick Facts
HCC Categories
HCC 276, Lung Transplant Status/Complications
HCC 221, Heart Transplant Status/Complications
HCC 35, Pancreas Transplant Status
HCC 62, Liver Transplant Status/Complications
RAF Weight Range
0.376 to 2.531
Community, non-dual, aged (V28)
Model
CMS-HCC V28 (PY2026, 100% phase-in)
7 ICD-10 codes map to payment HCCs
What HCC category does Organ Transplant Status map to under V28?
Organ transplant status does not map to one shared category under CMS-HCC V28. Lung transplant status maps to HCC 276, heart to HCC 221, pancreas to HCC 35, and liver to HCC 62. The combined heart-lung status code Z94.3 has two official CY2026 mapping rows, HCC 221 and HCC 276. Show both mappings, then apply the complete diagnosis set, hierarchy, cleanup, interactions, and the member's model segment before using a coefficient. Coders still need to report the supported Z94.x status, name the transplanted organ, and code documented T86.x complications separately.
ICD-10 to HCC Mapping
| ICD-10 Code | Description | Billable | HCC Mapping |
|---|---|---|---|
| Z94.0 | Kidney transplant status | Yes | No HCC (not risk-adjusting under V28) |
| Z94.1 | Heart transplant status | Yes | HCC 221 |
| Z94.2 | Lung transplant status | Yes | HCC 276 |
| Z94.3 | Heart and lungs transplant status | Yes | HCC 221 + HCC 276 |
| Z94.4 | Liver transplant status | Yes | HCC 62 |
| Z94.83 | Pancreas transplant status | Yes | HCC 35 |
| T86.10 | Unspecified complication of kidney transplant | Yes | No HCC (not risk-adjusting under V28) |
| T86.11 | Kidney transplant rejection | Yes | No HCC (not risk-adjusting under V28) |
| T86.21 | Heart transplant rejection | Yes | HCC 221 |
| T86.41 | Liver transplant rejection | Yes | HCC 62 |
Displayed numbers are source-labeled community non-dual aged reference coefficients from CMS-HCC V28, not member totals.
Verify Organ Transplant Status against the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coder workflow notes
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Documentation Tips
Report the transplant status code (Z94.x) at every encounter, it must be recaptured annually for risk adjustment.
Document the specific organ transplanted: kidney, heart, lung, liver, pancreas, or combination.
Record current immunosuppressive medications (tacrolimus, mycophenolate, prednisone) as part of the treatment review.
Code transplant complications (T86.x) separately when documented: rejection, failure, infection.
Document lab monitoring: tacrolimus levels, renal function for kidney transplant, liver function for liver transplant.
Note the date of transplant and the transplant center for continuity of care documentation.
If CKD persists after kidney transplant, code both Z94.0 and the appropriate CKD stage.
Common Coding Mistakes
Failing to code transplant status at every encounter, Z94.x must be reported annually for risk adjustment capture.
Not coding transplant complications (T86.x) separately when rejection, failure, or infection is documented.
Missing the immunosuppressive drug therapy code (Z79.899) as a supporting code for long-term medication documentation.
Forgetting to code the original disease (CKD, heart failure, cirrhosis) if it remains relevant after transplant.
V24 to V28 Changes
V28 splits transplant status by organ: lung maps to HCC 276, heart to HCC 221, pancreas to HCC 35, and liver to HCC 62. The combined heart-lung code Z94.3 maps to both HCC 221 and HCC 276 in the official CY2026 file. That mapping status does not authorize adding two coefficients without the full model calculation. Document the specific organ, recapture the supported Z94.x status each year, and use the hierarchy and coefficient table for the member's supported segment.
Related Conditions
Related references
Sources
Displayed numbers are source-labeled community non-dual aged reference coefficients from CMS-HCC V28, not member totals.
Verified current to CMS-HCC V28, payment year 2026 — last reviewed September 5, 2026.
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