T86.19
BillableOther complication of kidney transplant
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T86.19 an HCC code?
No. T86.19 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
MEAT Criteria for T86.19
For T86.19 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 T86.19 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
T86.19 is the ICD-10-CM diagnosis code for other complication of kidney transplant. Various other problems occur with a transplanted kidney that are not rejection, failure, or infection. T86.19 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).
T86.19 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.
Maps to RxHCC 260 (RAF 0.0) for Kidney Transplant Complications, recognizing the specialized pharmaceutical management required for various transplant-related complications. This includes medications for vascular complications, urologic issues, or adjustments to immunosuppressive regimens based on the specific complication type. Coders reviewing T86.19 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-leverage RAF improvement available within accurate coding.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for T86.19 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
This captures other specific kidney transplant complications not covered by rejection, failure, or infection, including vascular complications, urologic issues, or drug toxicity. These complications require specialized transplant expertise and may significantly impact graft survival and patient quality of life if not appropriately managed.
Documentation Requirements
- ✓History of kidney transplant with transplant date
- ✓Specific type of complication (vascular, urologic, drug-related)
- ✓Clinical presentation and diagnostic findings
- ✓Relationship to transplant procedure or medications
- ✓Diagnostic studies and results
- ✓Treatment interventions and surgical procedures
- ✓Impact on graft function and patient status
- ✓Specialist consultations and recommendations
Commonly Confused Codes
- •T86.10 — Unspecified kidney transplant complication (when specific type documented)
- •T86.11-T86.13 — Specific complications of rejection, failure, or infection
- •Z94.0 — Kidney transplant status (for routine follow-up)
- •T81.xxx — Post-procedural complications (surgical vs transplant-specific)
- •N99.xxx — Post-procedural genitourinary disorders