T86.11 ICD-10-CM Code: Kidney transplant rejection
T86.11 is not a CMS-HCC payment code. MEAT criteria · RAF calculator · free HCC coding tools
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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)
T86.11
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceKidney transplant rejection
The recipient's immune system attacks and rejects a transplanted kidney, causing it to stop functioning properly.
Buddy Insight
Kidney transplant rejection represents a critical complication threatening graft survival and patient health, requiring immediate intervention with immunosuppressive therapy adjustments or anti-rejection treatments.
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 T86.11 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for T86.11 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for T86.11 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for T86.11 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for T86.11 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for T86.11 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for T86.11 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 T86.11 an HCC code?
T86.11 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
- T86.11
- Description
- Kidney transplant rejection
- 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 T86.11 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for T86.11
For T86.11 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 T86.11 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
T86.11 is the ICD-10-CM diagnosis code for kidney transplant rejection. The recipient's immune system attacks and rejects a transplanted kidney, causing it to stop functioning properly. T86.11 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).
T86.11 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 T86.11 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 T86.11 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Kidney transplant rejection, documented rejection episode requiring intervention.
- •Acute vs chronic rejection subtype is clinically important but coded within the T86.11 umbrella; narrative detail strengthens audit position.
- •T86.11 (kidney transplant rejection) does NOT map to a V28 payment HCC; kidney transplant status and complications were removed from the V28 payment model. Capture the clinical consequences (e.g., CKD stage, AKI) with their own codes.
Clinical Significance
Kidney transplant rejection represents a critical complication threatening graft survival and patient health, requiring immediate intervention with immunosuppressive therapy adjustments or anti-rejection treatments. Early recognition and aggressive treatment are essential to preserve kidney function and prevent return to dialysis dependency.
Documentation Requirements
- ✓History of kidney transplant with transplant date
- ✓Clinical evidence of rejection (rising creatinine, decreased urine output)
- ✓Kidney biopsy results confirming rejection when available
- ✓Type of rejection (acute vs chronic, cellular vs antibody-mediated)
- ✓Laboratory values including creatinine trends and immunosuppressive levels
- ✓Anti-rejection treatments administered
- ✓Response to treatment and graft function status
- ✓Transplant team evaluation and management decisions
Commonly Confused Codes
- •T86.10: Unspecified kidney transplant complication (when rejection is documented)
- •T86.12: Kidney transplant failure (end result vs active rejection process)
- •N18.6: End stage renal disease (when transplant has completely failed)
- •Z94.0: Kidney transplant status (for stable patients without complications)
- •T86.13: Kidney transplant infection (different pathophysiology)