T86.30 ICD-10-CM Code: Unspecified complication of heart-lung transplant
T86.30 maps to CMS-HCC V28 HCCs 221 and 276. Source-labeled RAF references are available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC Buddy 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)
T86.30
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceUnspecified 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.
Buddy Insight
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.
CMS-HCC V28
MappedHCC 221
Coefficient HCC 221: 1.053 (Community Non-Dual Aged (CNA)); HCC 276: 2.531 (Community Non-Dual Aged (CNA))
+ HCC 276
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 129
Code-level coefficient reference
+ HCC 158
ESRD/PACE
MappedHCC 186
Code-level coefficient reference
RXHCC
MappedHCC 396
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for T86.30. Check the code and parent instructions in the Code Book.
Excludes 2
Official- birth trauma (P10-P15)Inherited from S00-T88, T80-T88
- obstetric trauma (O70-O71)Inherited from S00-T88, T80-T88
- any encounters with medical care for postprocedural conditions in which no complications are present, such as:Inherited from S00-T88, T80-T88
- artificial opening status (Z93.-)Inherited from S00-T88, T80-T88
- closure of external stoma (Z43.-)Inherited from S00-T88, T80-T88
- fitting and adjustment of external prosthetic device (Z44.-)Inherited from S00-T88, T80-T88
- burns and corrosions from local applications and irradiation (T20-T32)Inherited from S00-T88, T80-T88
- complications of surgical procedures during pregnancy, childbirth and the puerperium (O00-O9A)Inherited from S00-T88, T80-T88
- mechanical complication of respirator [ventilator] (J95.850)Inherited from S00-T88, T80-T88
- poisoning and toxic effects of drugs and chemicals (T36-T65 with fifth or sixth character 1-4 or 6)Inherited from S00-T88, T80-T88
- postprocedural fever (R50.82)Inherited from S00-T88, T80-T88
- specified complications classified elsewhere, such as:Inherited from S00-T88, T80-T88
- cerebrospinal fluid leak from spinal puncture (G97.0)Inherited from S00-T88, T80-T88
- colostomy malfunction (K94.0-)Inherited from S00-T88, T80-T88
- disorders of fluid and electrolyte imbalance (E86-E87)Inherited from S00-T88, T80-T88
- functional disturbances following cardiac surgery (I97.0-I97.1)Inherited from S00-T88, T80-T88
- intraoperative and postprocedural complications of specified body systems (D78.-, E36.-, E89.-, G97.3-, G97.4, H59.3-, H59.-, H95.2-, H95.3, I97.4-, I97.5, J95.6-, J95.7, K91.6-, L76.-, M96.-, N99.-)Inherited from S00-T88, T80-T88
- ostomy complications (J95.0-, K94.-, N99.5-)Inherited from S00-T88, T80-T88
- postgastric surgery syndromes (K91.1)Inherited from S00-T88, T80-T88
- postlaminectomy syndrome NEC (M96.1)Inherited from S00-T88, T80-T88
- postmastectomy lymphedema syndrome (I97.2)Inherited from S00-T88, T80-T88
- postsurgical blind-loop syndrome (K91.2)Inherited from S00-T88, T80-T88
- ventilator associated pneumonia (J95.851)Inherited from S00-T88, T80-T88
Related Codes
Includes
OfficialNo Includes notes are included in this display for T86.30. Check the code and parent instructions in the Code Book.
Excludes 1
OfficialNo Excludes 1 notes are included in this display for T86.30. Check the code and parent instructions in the Code Book.
Code First
OfficialNo Code First sequencing instructions are included in this display for T86.30. Check the code and parent instructions in the Code Book.
Use Additional
Official- code to identify any retained foreign body, if applicable (Z18.-)Inherited from S00-T88, T80-T88, T86
- code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5)Inherited from S00-T88, T80-T88, T86
- code(s) to identify the specified condition resulting from the complicationInherited from S00-T88, T80-T88, T86
- code to identify devices involved and details of circumstances (Y62-Y82)Inherited from S00-T88, T80-T88, T86
- code to identify other transplant complications, such as:Inherited from S00-T88, T80-T88, T86
- graft-versus-host disease (D89.81-)Inherited from S00-T88, T80-T88, T86
- malignancy associated with organ transplant (C80.2)Inherited from S00-T88, T80-T88, T86
- post-transplant lymphoproliferative disorders (PTLD) (D47.Z1)Inherited from S00-T88, T80-T88, T86
Code Also
OfficialNo Code Also instructions are included in this display for T86.30. Check the code and parent instructions in the Code Book.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 T86.30 an HCC code?
Yes. T86.30 (Unspecified complication of heart-lung transplant) maps to HCC 221, Heart Transplant Status/Complications and HCC 276, Lung Transplant Status/Complications under the CMS-HCC V28 risk adjustment model, with source-labeled community non-dual aged reference coefficients HCC 221 1.053 and HCC 276 2.531. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: T86.30 is billable and maps to V28 HCC 221, Heart Transplant Status/Complications and HCC 276, Lung Transplant Status/Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- T86.30
- Description
- Unspecified complication of heart-lung transplant
- HCC (V28)
- HCC 221 — Heart Transplant Status/Complications; HCC 276 — Lung Transplant Status/Complications
- RAF reference coefficient
- HCC 221: 1.053; HCC 276: 2.531
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work T86.30 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for T86.30
For T86.30, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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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 CMS-HCC V28 risk adjustment model, T86.30 maps to Heart Transplant Status/Complications (HCC 221) with a source-labeled community, non-dual, aged reference coefficient of 1.053. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Use this code only when the specific complication (rejection, failure, infection) is not documented; query the provider for more specificity. For T86.30, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, 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)