T86.30
BillableUnspecified complication of heart-lung transplant
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T86.30 an HCC code?
Yes. T86.30 maps to Major Organ Transplant or Replacement Status under the V24 model but is not retained in V28.
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 T86.30
For T86.30 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 T86.30 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
T86.30 is the ICD-10-CM diagnosis code for unspecified complication of heart-lung transplant. A complication occurring after a heart-lung transplant surgery where the specific type of problem is not specified or documented. T86.30 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 older CMS-HCC V24 model, T86.30 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 this code only when the specific complication (rejection, failure, infection) is not documented; query the provider for more specificity. Because T86.30 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 T86.30 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when the specific complication (rejection, failure, infection) is not documented; query the provider for more specificity
- •This is a less specific code; attempt to identify the actual complication type before assigning this code
Clinical Significance
Heart-lung transplant complications represent extremely complex medical situations given the dual organ involvement and rarity of the procedure, requiring specialized expertise from multiple subspecialties. These complications carry very high mortality risk and necessitate intensive monitoring and intervention due to the interdependent function of both transplanted organs.
Documentation Requirements
- ✓History of heart-lung transplant with transplant date
- ✓Clinical manifestations affecting cardiac or pulmonary function
- ✓Diagnostic studies for both cardiac and pulmonary assessment
- ✓Laboratory values including arterial blood gases and cardiac markers
- ✓Hemodynamic and respiratory status monitoring
- ✓Multidisciplinary team involvement and care coordination
- ✓Treatment interventions and response to therapy
- ✓Absence of more specific complication classification
Commonly Confused Codes
- •T86.31 — Heart-lung transplant rejection (when rejection documented)
- •T86.32 — Heart-lung transplant failure (when failure documented)
- •T86.33 — Heart-lung transplant infection (when infection documented)
- •T86.20 — Unspecified heart transplant complication (single organ)
- •T86.810 — Unspecified lung transplant complication (single organ)