T86.810 ICD-10-CM Code: Lung transplant rejection
T86.810 maps to CMS-HCC V28 276. A source-labeled RAF reference is 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)
T86.810
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLung transplant rejection
The recipient's immune system attacks and rejects the transplanted lung tissue after a lung transplant procedure.
Buddy Insight
Lung transplant rejection represents a serious immunological complication requiring immediate intervention and adjustment of immunosuppressive therapy.
CMS-HCC V28
MappedHCC 276
Coefficient HCC 276: 2.531 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 158
Code-level coefficient reference
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 T86.810. 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 T86.810. Check the code and parent instructions in the Code Book.
Excludes 1
Official- complication of heart-lung transplant (T86.3-)Inherited from T86.81
Code First
OfficialNo Code First sequencing instructions are included in this display for T86.810. 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 T86.810. 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 T86.810 an HCC code?
Yes. T86.810 (Lung transplant rejection) maps to HCC 276, Lung Transplant Status/Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 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: T86.810 is billable and maps to V28 HCC 276, Lung Transplant Status/Complications. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.
- Code
- T86.810
- Description
- Lung transplant rejection
- HCC (V28)
- HCC 276 — Lung Transplant Status/Complications
- RAF reference coefficient
- 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 T86.810 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for T86.810
For T86.810, 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
T86.810 is the ICD-10-CM diagnosis code for lung transplant rejection. The recipient's immune system attacks and rejects the transplanted lung tissue after a lung transplant procedure. T86.810 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, T86.810 maps to Lung Transplant Status/Complications (HCC 276) with a source-labeled community, non-dual, aged reference coefficient of 2.531. No V24 mapping is shown for T86.810; use the applicable model and payment year when reviewing the V28 mapping. 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.
Document the timeframe of rejection (acute vs. chronic) as this may affect clinical management and coding specificity. For T86.810, 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 T86.810 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the timeframe of rejection (acute vs. chronic) as this may affect clinical management and coding specificity
- •Ensure documentation distinguishes lung transplant rejection from other lung transplant complications
Clinical Significance
Lung transplant rejection represents a serious immunological complication requiring immediate intervention and adjustment of immunosuppressive therapy. This condition significantly impacts patient survival and quality of life, making it a critical diagnosis for risk stratification and care planning.
Documentation Requirements
- ✓Clear documentation of prior lung transplant procedure with date
- ✓Clinical evidence of rejection (biopsy results, imaging findings, pulmonary function decline)
- ✓Immunosuppressive medication history and current regimen
- ✓Symptoms consistent with rejection (dyspnea, cough, fever, decreased exercise tolerance)
- ✓Laboratory values supporting rejection (arterial blood gases, inflammatory markers)
- ✓Physician statement confirming rejection diagnosis
- ✓Differentiation from infection or other complications
- ✓Treatment plan for rejection management
Commonly Confused Codes
- •T86.811: lung transplant failure (functional failure vs immunologic rejection)
- •T86.812: lung transplant infection (infectious vs immunologic complication)
- •Z94.2: lung transplant status without complications (status vs active complication)
- •J44.1: COPD with acute exacerbation (native lung disease vs transplant complication)
- •T86.818: other lung transplant complications (specific rejection vs other complications)