T86.12 ICD-10-CM Code: Kidney transplant failure
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)
T86.12
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceKidney transplant failure
A transplanted kidney loses its ability to function, which may result from rejection, infection, or other complications.
Buddy Insight
Kidney transplant failure represents loss of graft function requiring return to dialysis or re-transplantation, indicating severe patient morbidity and substantial healthcare resource utilization.
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 T86.12 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for T86.12 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for T86.12 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for T86.12 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for T86.12 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for T86.12 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for T86.12 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 T86.12 an HCC code?
T86.12 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
- T86.12
- Description
- Kidney transplant failure
- 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 T86.12 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for T86.12
For T86.12 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 T86.12 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
T86.12 is the ICD-10-CM diagnosis code for kidney transplant failure. A transplanted kidney loses its ability to function, which may result from rejection, infection, or other complications. T86.12 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).
T86.12 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 T86.12 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 T86.12 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Kidney transplant failure represents loss of graft function requiring return to dialysis or re-transplantation, indicating severe patient morbidity and substantial healthcare resource utilization. This complication often results from untreated rejection, chronic damage, or other irreversible causes affecting long-term patient outcomes.
Documentation Requirements
- ✓History of kidney transplant with transplant date
- ✓Evidence of graft failure (severely elevated creatinine, anuria)
- ✓Clinical course leading to failure (rejection, infection, ischemia)
- ✓Laboratory confirmation of non-functional transplant
- ✓Initiation of dialysis or transplant evaluation
- ✓Immunosuppression discontinuation or modification
- ✓Transplant team assessment and recommendations
- ✓Patient counseling regarding treatment options
Commonly Confused Codes
- •T86.11: Kidney transplant rejection (active process vs end result)
- •T86.10: Unspecified kidney transplant complication (when failure is documented)
- •N18.6: End stage renal disease (may be used concurrently)
- •Z99.2: Dependence on renal dialysis (when dialysis restarted)
- •Z94.0: Kidney transplant status (inappropriate for failed transplant)