T86.41 ICD-10-CM Code: Liver transplant rejection
T86.41 maps to CMS-HCC V28 62 (RAF 0.376). 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)
T86.41
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLiver transplant rejection
The recipient's immune system attacks and damages the transplanted liver, causing it to malfunction or fail.
Buddy Insight
Liver transplant rejection represents a critical complication that can rapidly progress to graft failure and death without prompt aggressive immunosuppressive therapy.
CMS-HCC V28
MappedHCC 62
RAF 0.376
CMS-HCC V24
MappedHCC 186
RAF 0.832
ACA/HHS
MappedHCC 34
Varies by metal level
ESRD/PACE
MappedHCC 186
RAF 0.138
RXHCC
MappedHCC 396
Not separately weighted
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for T86.41 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for T86.41 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for T86.41 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for T86.41 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for T86.41 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for T86.41 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for T86.41 in this effective period.
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 T86.41 an HCC code?
Yes. T86.41 (Liver transplant rejection) maps to Liver 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 0.376. It is billable for payment year 2026.
Coder answer: T86.41 is billable and maps to V28 HCC 62, Liver Transplant Status/Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- T86.41
- Description
- Liver transplant rejection
- HCC (V28)
- HCC 62 — Liver Transplant Status/Complications
- RAF
- 0.376
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 T86.41 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for T86.41
For T86.41 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 T86.41 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
T86.41 is the ICD-10-CM diagnosis code for liver transplant rejection. The recipient's immune system attacks and damages the transplanted liver, causing it to malfunction or fail. T86.41 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, T86.41 maps to Liver Transplant Status/Complications (HCC 62) with a community, non-dual, aged base RAF weight of 0.376. Under the older CMS-HCC V24 model, T86.41 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.
Liver transplant rejection, hepatic allograft rejection documented clinically or on biopsy. Because T86.41 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 T86.41 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Liver transplant rejection, hepatic allograft rejection documented clinically or on biopsy.
- •Post-transplant liver dysfunction has many etiologies (recurrent disease, infection, biliary complication); rejection is specifically T86.41.
- •V28 HCC 62 (Liver Transplant Status/Complications) at RAF 0.376, liver-transplant complications map through the liver-transplant HCC.
Clinical Significance
Liver transplant rejection represents a critical complication that can rapidly progress to graft failure and death without prompt aggressive immunosuppressive therapy. Early recognition through routine monitoring and liver biopsy is essential, as the liver's unique immunological properties make rejection patterns different from other solid organ transplants.
Documentation Requirements
- ✓History of liver transplant with transplant date
- ✓Evidence of rejection from liver biopsy or clinical presentation
- ✓Grade and type of rejection (acute cellular, chronic, antibody-mediated)
- ✓Clinical symptoms and laboratory abnormalities
- ✓Liver function tests showing deterioration
- ✓Anti-rejection therapy protocols administered
- ✓Response to treatment and follow-up studies
- ✓Transplant hepatology team management decisions
Commonly Confused Codes
- •T86.40: Unspecified liver transplant complication (when rejection documented)
- •T86.42: Liver transplant failure (end result vs active rejection)
- •K72.90: Hepatic failure, unspecified (non-transplant related)
- •Z94.4: Liver transplant status (stable patients without rejection)
- •T86.43: Liver transplant infection (different pathophysiology)