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T86.32 ICD-10-CM Code: Heart-lung transplant failure

T86.32 maps to CMS-HCC V28 HCCs 221 and 276. Source-labeled RAF references are available. 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)

T86.32

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

Heart-lung transplant failure

The transplanted heart and lungs stop functioning properly or cease to work after transplantation.

Buddy the Bee presenting code insight

Buddy Insight

Heart-lung transplant failure represents catastrophic loss of both organs with extremely poor prognosis and limited treatment options, as re-transplantation of both organs is rarely feasible.

CMS-HCC V28

HCC 221

Code-level coefficient reference

+ HCC 276

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 129

Code-level coefficient reference

+ HCC 158

ESRD/PACE

HCC 186

Code-level coefficient reference

RXHCC

HCC 396

Code-level coefficient reference

Code Book Path

Official
T86Complications of transplanted organs and tissue
T86.3Complications of heart-lung transplant
T86.32Heart-lung transplant failure

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for T86.32 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for T86.32 in this effective period.

Related Child Codes

Official
T86.30Unspecified complication of heart-lung transplant
T86.31Heart-lung transplant rejection
T86.33Heart-lung transplant infection
T86.39Other complications of heart-lung transplant

Includes

Official

ICD-10-CM does not list Includes notes for T86.32 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for T86.32 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for T86.32 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for T86.32 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for T86.32 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
History of heart-lung transplant with transplant date
Evidence of failure in heart, lungs, or both organs
Hemodynamic instability and respiratory failure
Precipitating factors leading to dual organ failure

MEAT Support

HCC Buddy guidance
History of heart-lung transplant with transplant date
Evidence of failure in heart, lungs, or both organs
Hemodynamic instability and respiratory failure
Precipitating factors leading to dual organ failure

Audit Caution

HCC Buddy guidance
Using single-organ failure codes for combined heart-lung failure
Confusing active rejection with irreversible organ failure
Missing concurrent codes for mechanical support devices
Using symptom codes instead of transplant-specific failure codes

Common Mistakes

HCC Buddy guidance
T86.31 — Heart-lung transplant rejection (active process vs end-stage failure)
T86.30 — Unspecified heart-lung transplant complication (when failure documented)
T86.22 — Heart transplant failure (single organ vs combined)
T86.812 — Lung transplant failure (single organ vs combined)

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 T86.32 an HCC code?

Yes. T86.32 (Heart-lung transplant failure) 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: T86.32 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
T86.32
Description
Heart-lung transplant failure
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

V28HCC 221, Heart Transplant Status/Complications
1.053
+ HCC 276, Lung Transplant Status/Complications2.531
ESRDHCC 186, Major Organ Transplant or Replacement Status
Not separately weighted
RxHCCHCC 396, Heart, Lung, Liver, Intestine, or Pancreas Transplant Status
Not separately weighted

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 T86.32 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for T86.32

For T86.32 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 T86.32 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

T86.32 is the ICD-10-CM diagnosis code for heart-lung transplant failure. The transplanted heart and lungs stop functioning properly or cease to work after transplantation. T86.32 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, T86.32 maps to Heart Transplant Status/Complications (HCC 221) with a source-labeled community, non-dual, aged reference coefficient of 1.053. No V24 mapping is shown for T86.32; use the applicable model and payment year when reviewing the V28 mapping. 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. 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.

Distinguish between primary graft failure (immediate) and secondary graft failure (delayed); document timing when possible. Because T86.32 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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 T86.32 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Distinguish between primary graft failure (immediate) and secondary graft failure (delayed); document timing when possible
  • •This code indicates organ dysfunction; coordinate with cardiology and pulmonology documentation

Clinical Significance

Heart-lung transplant failure represents catastrophic loss of both organs with extremely poor prognosis and limited treatment options, as re-transplantation of both organs is rarely feasible. This complication requires intensive supportive care and often involves end-of-life planning due to the complexity and scarcity of suitable donor organs.

Documentation Requirements

  • ✓History of heart-lung transplant with transplant date
  • ✓Evidence of failure in heart, lungs, or both organs
  • ✓Hemodynamic instability and respiratory failure
  • ✓Precipitating factors leading to dual organ failure
  • ✓Need for mechanical circulatory and/or respiratory support
  • ✓Evaluation for feasibility of re-transplantation
  • ✓Family discussions regarding prognosis and care goals
  • ✓Multidisciplinary team coordination for complex care needs

Commonly Confused Codes

  • •T86.31: Heart-lung transplant rejection (active process vs end-stage failure)
  • •T86.30: Unspecified heart-lung transplant complication (when failure documented)
  • •T86.22: Heart transplant failure (single organ vs combined)
  • •T86.812: Lung transplant failure (single organ vs combined)
  • •R09.2: Respiratory arrest (symptom vs transplant-specific failure)

Child Codes

T86.30Unspecified complication of heart-lung transplant
HCC 221
T86.31Heart-lung transplant rejection
HCC 221
T86.32Heart-lung transplant failure
HCC 221
T86.33Heart-lung transplant infection
HCC 221
T86.39Other complications of heart-lung transplant
HCC 221

Code Hierarchy

└T86Complications of transplanted organs and tissue└T86.3Complications of heart-lung transplant└T86.32Heart-lung transplant failure
└T86.32Heart-lung transplant failure

Because T86.32 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment.

T86.32 maps to CMS-HCC V28 category 221, Heart Transplant Status/Complications and CMS-HCC V28 category 276, Lung Transplant Status/Complications. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. The mapping identifies payment HCC categories for T86.32. Review their source-labeled HCC coefficients above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

More on T86.32

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