T86.298
BillableOther complications of heart transplant
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T86.298 an HCC code?
Yes. T86.298 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 T86.298
For T86.298 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 T86.298 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
T86.298 is the ICD-10-CM diagnosis code for other complications of heart transplant. Various other problems occur with a transplanted heart that are not rejection, failure, infection, or vasculopathy. T86.298 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, T86.298 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, T86.298 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.
Use only when the specific complication is not captured by codes T86.20-T86.290. Because T86.298 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 T86.298 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 heart transplant complications not classified elsewhere, including arrhythmias, pericardial disease, or drug toxicity that significantly impact patient care and graft function. These complications require specialized cardiothoracic expertise and may affect long-term transplant outcomes and quality of life.
Documentation Requirements
- ✓History of heart transplant with transplant date
- ✓Specific type of complication not elsewhere classified
- ✓Clinical presentation and diagnostic findings
- ✓Relationship to transplant procedure or medications
- ✓Diagnostic studies and interventions performed
- ✓Impact on cardiac function and patient status
- ✓Specialist consultations and treatment recommendations
- ✓Response to therapy and clinical outcomes
Commonly Confused Codes
- •T86.20 — Unspecified heart transplant complication (when specific type documented)
- •T86.21-T86.23 — Specific complications of rejection, failure, or infection
- •T86.290 — Cardiac allograft vasculopathy (specific vascular complication)
- •I49.9 — Cardiac arrhythmia (when transplant-related vs general)
- •Z94.1 — Heart transplant status (routine follow-up vs complication)