What is ICD-10 code T86.42?

T86.42 is the ICD-10-CM diagnosis code for Liver transplant failure. The transplanted liver stops functioning properly or ceases to work after transplantation. It belongs to the ICD-10-CM chapter for injury, poisoning and certain other consequences of external causes (s00-t88). T86.42 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. T86.42 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. T86.42 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. T86.42 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for T86.42?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For T86.42, V28 maps to Liver Transplant Status/Complications at RAF 0.376 while V24 mapped to Major Organ Transplant or Replacement Status at RAF 0.832. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting T86.42?

Distinguish between primary graft failure (occurs immediately) and secondary graft failure (occurs later); document timing Coordinate with hepatology documentation and liver function test results Because T86.42 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

2026 ICD-10-CM T86.42: Liver transplant failure

ICD-10-CM Code View

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Code lookupT86.42Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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)

T86.42

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

Liver transplant failure

The transplanted liver stops functioning properly or ceases to work after transplantation.

Buddy Insight

CMS-HCC V28

Mapped

HCC 62

Liver Transplant Status/Compl...

RAF 0.376

CMS-HCC V24

Mapped

HCC 186

Major Organ Transplant or Rep...

RAF 0.832

ACA/HHS

Mapped

HCC 34

HHS-HCC 34

Varies by metal level

ESRD/PACE

Mapped

HCC 186

Major Organ Transplant or Rep...

RAF 0.138

RXHCC

Mapped

HCC 396

Allograft Complications

Not separately weighted

Code Book Path

Official

T86Complications of transplanted organs and tissue

T86.4Complications of liver transplant

T86.42Liver transplant failure

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for T86.42 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for T86.42 in this effective period.

Related Child Codes

Official

T86.40Unspecified complication of liver transplant

T86.41Liver transplant rejection

T86.43Liver transplant infection

T86.49Other complications of liver transplant

Includes

Official

ICD-10-CM does not list Includes notes for T86.42 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for T86.42 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for T86.42 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for T86.42 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for T86.42 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

History of liver transplant with transplant date

Evidence of graft failure with severe hepatic dysfunction

Laboratory evidence including elevated bilirubin, coagulopathy

Clinical manifestations such as encephalopathy or ascites

MEAT Support

HCC Buddy guidance

History of liver transplant with transplant date

Evidence of graft failure with severe hepatic dysfunction

Laboratory evidence including elevated bilirubin, coagulopathy

Clinical manifestations such as encephalopathy or ascites

Audit Caution

HCC Buddy guidance

Using rejection codes when the liver has already failed

Missing concurrent codes for hepatic encephalopathy or other complications

Using general liver failure codes instead of transplant-specific failure

Not capturing the underlying cause of failure when documented

Common Mistakes

HCC Buddy guidance

T86.41 — Liver transplant rejection (active process vs end-stage failure)

T86.40 — Unspecified liver transplant complication (when failure documented)

K72.90 — Hepatic failure, unspecified (non-transplant related)

K76.7 — Hepatorenal syndrome (complication vs primary failure)

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 T86.42 an HCC code?

Yes. T86.42 (Liver transplant failure) 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: T86.42 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: T86.42
Description: Liver transplant failure
HCC (V28): HCC 62 — Liver Transplant Status/Complications
RAF: 0.376
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 62, Liver Transplant Status/Complications

0.376

V24HCC 186, Major Organ Transplant or Replacement Status

0.832

ESRDHCC 186, Major Organ Transplant or Replacement Status

0.138

RxHCCHCC 396, Allograft Complications

Not separately weighted

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 T86.42 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for T86.42

For T86.42 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 T86.42 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

T86.42 is the ICD-10-CM diagnosis code for liver transplant failure. The transplanted liver stops functioning properly or ceases to work after transplantation. T86.42 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, T86.42 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, T86.42 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.

Distinguish between primary graft failure (occurs immediately) and secondary graft failure (occurs later); document timing. Because T86.42 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 T86.42 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 (occurs immediately) and secondary graft failure (occurs later); document timing
•Coordinate with hepatology documentation and liver function test results

Clinical Significance

Liver transplant failure represents loss of hepatic function requiring emergency re-transplantation or resulting in death, as there is no long-term artificial support equivalent to dialysis for kidney failure. This complication necessitates immediate evaluation for re-transplantation candidacy and intensive supportive care to manage hepatic encephalopathy and coagulopathy.