T86.290
BillableCardiac allograft vasculopathy
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T86.290 an HCC code?
Yes. T86.290 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 T86.290
For T86.290 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 T86.290 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
T86.290 is the ICD-10-CM diagnosis code for cardiac allograft vasculopathy. Blood vessels in a transplanted heart develop narrowing and hardening (similar to atherosclerosis), reducing blood flow to the organ. T86.290 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, T86.290 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, T86.290 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.
This is a chronic complication that may develop months to years after transplantation. Because T86.290 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 T86.290 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a chronic complication that may develop months to years after transplantation
- •Document the severity and location of vasculopathy when available in imaging or catheterization reports
Clinical Significance
Cardiac allograft vasculopathy represents chronic rejection manifesting as accelerated coronary artery disease in the transplanted heart, leading to ischemia and eventual graft failure. This complication requires specialized monitoring with annual coronary angiography and may necessitate interventional procedures or re-transplantation for survival.
Documentation Requirements
- ✓History of heart transplant with transplant date
- ✓Coronary angiography findings showing vasculopathy
- ✓Clinical symptoms of ischemia or heart failure
- ✓Echocardiographic evidence of cardiac dysfunction
- ✓Time interval from transplant to vasculopathy development
- ✓Interventional procedures performed (angioplasty, stenting)
- ✓Medical management including antiplatelet therapy
- ✓Evaluation for re-transplantation candidacy