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T86.290 ICD-10-CM Code: Cardiac allograft vasculopathy

T86.290 maps to CMS-HCC V28 221 (RAF 1.053). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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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)

T86.290

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Cardiac allograft vasculopathy

Blood vessels in a transplanted heart develop narrowing and hardening (similar to atherosclerosis), reducing blood flow to the organ.

Buddy the Bee presenting code insight

Buddy Insight

Cardiac allograft vasculopathy represents chronic rejection manifesting as accelerated coronary artery disease in the transplanted heart, leading to ischemia and eventual graft failure.

CMS-HCC V28

HCC 221

RAF 1.053

CMS-HCC V24

HCC 186

RAF 0.832

ACA/HHS

HCC 129

Varies by metal level

ESRD/PACE

HCC 186

RAF 0.138

RXHCC

HCC 396

Not separately weighted

Code Book Path

Official
T86.2Complications of heart transplant
T86.29Other complications of heart transplant
T86.290Cardiac allograft vasculopathy

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for T86.290 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for T86.290 in this effective period.

Related Child Codes

Official
T86.298Other complications of heart transplant

Includes

Official

ICD-10-CM does not list Includes notes for T86.290 in this effective period.

Excludes 1

Official
  • atherosclerosis of coronary arteries (I25.75-, I25.76-, I25.81-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for T86.290 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for T86.290 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for T86.290 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
History of heart transplant with transplant date
Coronary angiography findings showing vasculopathy
Clinical symptoms of ischemia or heart failure
Echocardiographic evidence of cardiac dysfunction

MEAT Support

HCC Buddy guidance
History of heart transplant with transplant date
Coronary angiography findings showing vasculopathy
Clinical symptoms of ischemia or heart failure
Echocardiographic evidence of cardiac dysfunction

Audit Caution

HCC Buddy guidance
Using native coronary artery disease codes for transplant vasculopathy
Confusing with acute cellular rejection processes
Missing interventional procedure codes when performed
Using other complication codes when vasculopathy is specifically documented

Common Mistakes

HCC Buddy guidance
I25.10 — Atherosclerotic heart disease (native vessel disease)
T86.21 — Heart transplant rejection (acute vs chronic process)
T86.298 — Other heart transplant complications (when vasculopathy documented)
I25.700 — Atherosclerosis of coronary artery bypass graft

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 T86.290 an HCC code?

Yes. T86.290 (Cardiac allograft vasculopathy) maps to Heart Transplant Status/Complications under the CMS-HCC V28 risk adjustment model (and Major Organ Transplant or Replacement Status under V24), with a community non-dual aged RAF of 1.053. It is billable for payment year 2026.

Coder answer: T86.290 is billable and maps to V28 HCC 221, Heart Transplant Status/Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code
T86.290
Description
Cardiac allograft vasculopathy
HCC (V28)
HCC 221 — Heart Transplant Status/Complications
RAF
1.053
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 221, Heart Transplant Status/Complications
1.053
V24HCC 186, Major Organ Transplant or Replacement Status
0.832
ESRDHCC 186, Major Organ Transplant or Replacement Status
0.138
RxHCCHCC 396, Allograft Complications
Not separately weighted

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 T86.290 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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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 1.053. 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 0.832. 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

Excludes 1, Do NOT code together

Commonly Confused Codes

  • •I25.10: Atherosclerotic heart disease (native vessel disease)
  • •T86.21: Heart transplant rejection (acute vs chronic process)
  • •T86.298: Other heart transplant complications (when vasculopathy documented)
  • •I25.700: Atherosclerosis of coronary artery bypass graft
  • •T86.22: Heart transplant failure (consequence vs specific pathology)

Child Codes

T86.290Cardiac allograft vasculopathy
HCC 221
T86.298Other complications of heart transplant
HCC 221

Code Hierarchy

└T86Complications of transplanted organs and tissue└T86.2Complications of heart transplant└T86.29Other complications of heart transplant└T86.290Cardiac allograft vasculopathy
└T86.290Cardiac allograft vasculopathy

Because T86.290 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

T86.290 maps to CMS-HCC V28 category 221, Heart Transplant Status/Complications. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because T86.290 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

More on T86.290

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