T86.22 ICD-10-CM Code: Heart 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)
T86.22
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceHeart transplant failure
A transplanted heart loses its ability to pump blood effectively due to various complications.
Buddy Insight
Heart transplant failure represents catastrophic graft loss requiring emergency mechanical support or re-transplantation, with extremely high mortality risk without immediate intervention.
CMS-HCC V28
MappedHCC 221
RAF 0.910
CMS-HCC V24
MappedHCC 186
RAF 0.910
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 186
RAF 0.0
RXHCC
MappedHCC 396
RAF 0.0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for T86.22 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for T86.22 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for T86.22 in this effective period.
Excludes 1
Official- complication of:
- artificial heart device (T82.5-)
- heart-lung transplant (T86.3-)
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for T86.22 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for T86.22 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for T86.22 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is T86.22 an HCC code?
Yes. T86.22 maps to Heart Transplant Status/Complications under the CMS-HCC V28 risk adjustment model (and Major Organ Transplant or Replacement Status under V24).
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 T86.22
For T86.22to 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 T86.22 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
T86.22 is the ICD-10-CM diagnosis code for heart transplant failure. A transplanted heart loses its ability to pump blood effectively due to various complications. T86.22 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).
Under the CMS-HCC V28 risk adjustment model, T86.22 maps to Heart Transplant Status/Complications (HCC 221) with a community, non-dual, aged base RAF weight of 0.910. Under the older CMS-HCC V24 model, T86.22 maps to Major Organ Transplant or Replacement Status (HCC 186) with a community, non-dual, aged base RAF weight of 0.910. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Determine the underlying cause (rejection, infection, vasculopathy) and code accordingly if documented. Because T86.22 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for T86.22 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Determine the underlying cause (rejection, infection, vasculopathy) and code accordingly if documented
- •Document ejection fraction or other cardiac function parameters to support the diagnosis
Clinical Significance
Heart transplant failure represents catastrophic graft loss requiring emergency mechanical support or re-transplantation, with extremely high mortality risk without immediate intervention. This complication necessitates intensive care management and consideration of advanced therapies including ventricular assist devices or emergency re-transplantation.
Documentation Requirements
- ✓History of heart transplant with transplant date
- ✓Evidence of graft failure (severe dysfunction, cardiogenic shock)
- ✓Hemodynamic instability and cardiac output measurements
- ✓Precipitating factors (rejection, vasculopathy, infection)
- ✓Need for mechanical circulatory support or inotropic therapy
- ✓Evaluation for re-transplantation candidacy
- ✓End-of-life planning discussions when appropriate
- ✓Multidisciplinary team involvement and care goals
Commonly Confused Codes
- •T86.21 — Heart transplant rejection (active process vs end-stage failure)
- •T86.20 — Unspecified heart transplant complication (when failure documented)
- •I50.9 — Heart failure (general vs transplant-specific failure)
- •T86.290 — Cardiac allograft vasculopathy (cause vs consequence)
- •Z99.0 — Dependence on aspirator/respirator (supportive care measure)