T86.10 ICD-10-CM Code: Unspecified complication of kidney transplant
T86.10 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · HCC coding software
HCC Buddy Code Card
Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.
FY 2026 Apr update / Injury, poisoning and certain other consequences of external causes (S00-T88) / Complications of surgical and medical care, not elsewhere classified (T80-T88)
T86.10
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUnspecified complication of kidney transplant
A complication following a kidney transplant that is not further specified, such as rejection, infection, or other transplant-related problems.
Buddy Insight
Represents undefined post-kidney transplant complications requiring careful clinical evaluation to prevent graft loss and patient morbidity.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
N/A—
Not mapped
ACA/HHS
MappedHCC 183
Varies by metal level
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 260
Not separately weighted
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for T86.10 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for T86.10 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for T86.10 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for T86.10 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for T86.10 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for T86.10 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for T86.10 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →
Is T86.10 an HCC code?
T86.10 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Kidney Transplant Complications under the Part D RxHCC model.
- Code
- T86.10
- Description
- Unspecified complication of kidney transplant
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
Work T86.10 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for T86.10
For T86.10 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed T86.10 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
Get the V28 RAF + MEAT cheat sheet
One printable page: confirm a code's V28 HCC status, its RAF weight, and the MEAT your note needs to make it stick. Free, no card.
Free PDF. No card. Unsubscribe anytime.
What This Code Means
T86.10 is the ICD-10-CM diagnosis code for unspecified complication of kidney transplant. A complication following a kidney transplant that is not further specified, such as rejection, infection, or other transplant-related problems. T86.10 sits in the ICD-10-CM chapter for injury, poisoning and certain other consequences of external causes (s00-t88), within the section covering complications of surgical and medical care, not elsewhere classified (t80-t88).
T86.10 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.
This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing T86.10 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for T86.10 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Unspecified complication of kidney transplant, transplant complication not specified as rejection, failure, or infection. Query for specificity.
- •Prefer T86.11 (rejection), T86.12 (failure), T86.13 (infection), or T86.19 (other) when specifics are documented.
- •T86.10 does NOT map to a V28 payment HCC. V28 dropped kidney transplant status (Z94.0) and its complications from the payment model, so unspecified kidney-transplant complications carry no coefficient on their own. Any active condition (rejection-driven AKI, infection) is captured by its own diagnosis code and HCC.
Clinical Significance
Represents undefined post-kidney transplant complications requiring careful clinical evaluation to prevent graft loss and patient morbidity. These unspecified complications often precede more serious defined complications and require prompt medical intervention and close monitoring by transplant specialists.
Documentation Requirements
- ✓History of kidney transplant with transplant date
- ✓Clinical signs and symptoms of complication
- ✓Laboratory values including creatinine, BUN, and immunosuppressive levels
- ✓Diagnostic studies such as biopsy, imaging, or cultures
- ✓Treatment interventions and medications
- ✓Response to therapy and clinical course
- ✓Transplant team involvement and recommendations
- ✓Absence of more specific complication types
Commonly Confused Codes
- •T86.11: Kidney transplant rejection (when rejection is documented)
- •T86.12: Kidney transplant failure (when failure is documented)
- •T86.13: Kidney transplant infection (when infection is documented)
- •Z94.0: Kidney transplant status (for asymptomatic patients)
- •N18.6: End stage renal disease (when transplant has failed)