T86.19 ICD-10-CM Code: Other complication of kidney transplant
T86.19 is not a CMS-HCC payment code. MEAT criteria · RAF Calculator · HCC coding software
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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)
T86.19
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOther complication of kidney transplant
Various other problems occur with a transplanted kidney that are not rejection, failure, or infection.
Buddy Insight
This captures other specific kidney transplant complications not covered by rejection, failure, or infection, including vascular complications, urologic issues, or drug toxicity.
CMS-HCC V28
N/A—
Not mapped
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 183
Code-level coefficient reference
ESRD/PACE
N/A—
Not mapped
RXHCC
MappedHCC 260
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for T86.19. Check the code and parent instructions in the Code Book.
Excludes 2
Official- birth trauma (P10-P15)Inherited from S00-T88, T80-T88
- obstetric trauma (O70-O71)Inherited from S00-T88, T80-T88
- any encounters with medical care for postprocedural conditions in which no complications are present, such as:Inherited from S00-T88, T80-T88
- artificial opening status (Z93.-)Inherited from S00-T88, T80-T88
- closure of external stoma (Z43.-)Inherited from S00-T88, T80-T88
- fitting and adjustment of external prosthetic device (Z44.-)Inherited from S00-T88, T80-T88
- burns and corrosions from local applications and irradiation (T20-T32)Inherited from S00-T88, T80-T88
- complications of surgical procedures during pregnancy, childbirth and the puerperium (O00-O9A)Inherited from S00-T88, T80-T88
- mechanical complication of respirator [ventilator] (J95.850)Inherited from S00-T88, T80-T88
- poisoning and toxic effects of drugs and chemicals (T36-T65 with fifth or sixth character 1-4 or 6)Inherited from S00-T88, T80-T88
- postprocedural fever (R50.82)Inherited from S00-T88, T80-T88
- specified complications classified elsewhere, such as:Inherited from S00-T88, T80-T88
- cerebrospinal fluid leak from spinal puncture (G97.0)Inherited from S00-T88, T80-T88
- colostomy malfunction (K94.0-)Inherited from S00-T88, T80-T88
- disorders of fluid and electrolyte imbalance (E86-E87)Inherited from S00-T88, T80-T88
- functional disturbances following cardiac surgery (I97.0-I97.1)Inherited from S00-T88, T80-T88
- intraoperative and postprocedural complications of specified body systems (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95.6-, J95.7, K91.6-, L76.-, M96.-, N99.-)Inherited from S00-T88, T80-T88
- ostomy complications (J95.0-, K94.-, N99.5-)Inherited from S00-T88, T80-T88
- postgastric surgery syndromes (K91.1)Inherited from S00-T88, T80-T88
- postlaminectomy syndrome NEC (M96.1)Inherited from S00-T88, T80-T88
- postmastectomy lymphedema syndrome (I97.2)Inherited from S00-T88, T80-T88
- postsurgical blind-loop syndrome (K91.2)Inherited from S00-T88, T80-T88
- ventilator associated pneumonia (J95.851)Inherited from S00-T88, T80-T88
Related Codes
Includes
OfficialNo Includes notes are included in this display for T86.19. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for T86.19. Check the code and parent instructions in the Code Book.
Code First
OfficialNo Code First sequencing instructions are included in this display for T86.19. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify any retained foreign body, if applicable (Z18.-)Inherited from S00-T88, T80-T88, T86
- code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)Inherited from S00-T88, T80-T88, T86
- code(s) to identify the specified condition resulting from the complicationInherited from S00-T88, T80-T88, T86
- code to identify devices involved and details of circumstances (Y62-Y82)Inherited from S00-T88, T80-T88, T86
- code to identify other transplant complications, such as:Inherited from S00-T88, T80-T88, T86
- graft-versus-host disease (D89.81-)Inherited from S00-T88, T80-T88, T86
- malignancy associated with organ transplant (C80.2)Inherited from S00-T88, T80-T88, T86
- post-transplant lymphoproliferative disorders (PTLD) (D47.Z1)Inherited from S00-T88, T80-T88, T86
Code Also
OfficialNo Code Also instructions are included in this display for T86.19. Check the code and parent instructions in the Code Book.
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 T86.19 an HCC code?
T86.19 has no mapping under the current CMS-HCC V28 community payment model. T86.19 has a separate mapping under the Part D RxHCC model (HCC 260 (Kidney Transplant Status)); the applicable result needs member context. T86.19 also appears in the HHS-HCC commercial risk model (HCC 183 (HHS-HCC 183 adult, RAF varies by metal level)), which is a commercial market model rather than a Medicare Advantage payment mapping.
- Code
- T86.19
- Description
- Other complication of kidney transplant
- HCC (V28)
- No CMS-HCC V28 mapping
- RAF reference coefficient
- —
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work T86.19 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for T86.19
For T86.19, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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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 has no mapping under the current CMS-HCC V28 community payment model. T86.19 has a separate mapping under the Part D RxHCC model (HCC 260 (Kidney Transplant Status)); the applicable result needs member context. T86.19 also appears in the HHS-HCC commercial risk model (HCC 183 (HHS-HCC 183 adult, RAF varies by metal level)), which is a commercial market model rather than a Medicare Advantage payment mapping. Do not assign V28 risk adjustment value from this page; verify the applicable model and payment year before using this code for risk adjustment.
Use this code only when the specific complication is not captured by T86.11, T86.12, or T86.13.
HCC Buddy maintains structured V28 and V24 mapping, source-labeled coefficient references, 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