What is ICD-10 code T86.811?

T86.811 is the ICD-10-CM diagnosis code for Lung transplant failure. The transplanted lung stops functioning properly or fails to work as expected after transplantation. It belongs to the ICD-10-CM chapter for injury, poisoning and certain other consequences of external causes (s00-t88). T86.811 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. T86.811 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. T86.811 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. T86.811 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 T86.811?

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 T86.811, V28 maps to Lung Transplant Status/Complications at RAF 2.531 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 T86.811?

Differentiate between primary graft failure (occurs immediately) and secondary graft failure (occurs later) Document the clinical evidence of lung failure such as decreased function, need for re-transplant, or mechanical support Because T86.811 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 T86.811: Lung transplant failure

ICD-10-CM Code View

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Code lookupT86.811Effective 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)

T86.811

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

Lung transplant failure

The transplanted lung stops functioning properly or fails to work as expected after transplantation.

Buddy Insight

Lung transplant failure indicates severe graft dysfunction regardless of cause, representing a life-threatening condition requiring intensive management and possible retransplantation consideration.

CMS-HCC V28

Mapped

HCC 276

Lung Transplant Status/Compli...

RAF 2.531

CMS-HCC V24

Mapped

HCC 186

Major Organ Transplant or Rep...

RAF 0.832

ACA/HHS

Mapped

HCC 158

HHS-HCC 158

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

T86.8Complications of other transplanted organs and tissues

T86.81Complications of lung transplant

T86.811Lung transplant failure

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for T86.811 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for T86.811 in this effective period.

Related Child Codes

Official

T86.810Lung transplant rejection

T86.812Lung transplant infection

T86.818Other complications of lung transplant

T86.819Unspecified complication of lung transplant

Includes

Official

ICD-10-CM does not list Includes notes for T86.811 in this effective period.

Excludes 1

Official

complication of heart-lung transplant (T86.3-)

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for T86.811 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for T86.811 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for T86.811 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of previous lung transplant with procedure date

Evidence of graft failure (pulmonary function tests, imaging studies, biopsy)

Clinical manifestations of failure (severe dyspnea, hypoxemia, respiratory failure)

Exclusion or identification of reversible causes

MEAT Support

HCC Buddy guidance

Documentation of previous lung transplant with procedure date

Evidence of graft failure (pulmonary function tests, imaging studies, biopsy)

Clinical manifestations of failure (severe dyspnea, hypoxemia, respiratory failure)

Exclusion or identification of reversible causes

Audit Caution

HCC Buddy guidance

Confusing failure with rejection when immunologic cause is documented

Using respiratory failure codes without linking to transplant

Not documenting the relationship between symptoms and transplant failure

Missing documentation of severity and functional impact

Common Mistakes

HCC Buddy guidance

T86.810 — lung transplant rejection (failure vs specific rejection mechanism)

T86.812 — lung transplant infection (failure vs infectious complication)

J96.90 — respiratory failure unspecified (transplant-related vs non-transplant respiratory failure)

Z94.2 — lung transplant status (failure vs stable transplant status)

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 T86.811 an HCC code?

Yes. T86.811 (Lung transplant failure) maps to Lung 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 2.531. It is billable for payment year 2026.

Coder answer: T86.811 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: T86.811
Description: Lung transplant failure
HCC (V28): HCC 276 — Lung Transplant Status/Complications
RAF: 2.531
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 276, Lung Transplant Status/Complications

2.531

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 T86.811 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for T86.811

For T86.811 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 T86.811 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

T86.811 is the ICD-10-CM diagnosis code for lung transplant failure. The transplanted lung stops functioning properly or fails to work as expected after transplantation. T86.811 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, T86.811 maps to Lung Transplant Status/Complications (HCC 276) with a community, non-dual, aged base RAF weight of 2.531. Under the older CMS-HCC V24 model, T86.811 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.

Differentiate between primary graft failure (occurs immediately) and secondary graft failure (occurs later). Because T86.811 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 T86.811 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Differentiate between primary graft failure (occurs immediately) and secondary graft failure (occurs later)
•Document the clinical evidence of lung failure such as decreased function, need for re-transplant, or mechanical support

Clinical Significance

Lung transplant failure indicates severe graft dysfunction regardless of cause, representing a life-threatening condition requiring intensive management and possible retransplantation consideration. This diagnosis carries significant mortality risk and healthcare resource utilization implications.

Documentation Requirements

✓Documentation of previous lung transplant with procedure date
✓Evidence of graft failure (pulmonary function tests, imaging studies, biopsy)
✓Clinical manifestations of failure (severe dyspnea, hypoxemia, respiratory failure)
✓Exclusion or identification of reversible causes
✓Arterial blood gas results demonstrating respiratory compromise
✓Chest imaging showing graft dysfunction
✓Provider assessment confirming transplant failure
✓Current management plan including consideration for retransplantation

Commonly Confused Codes

•T86.810: lung transplant rejection (failure vs specific rejection mechanism)
•T86.812: lung transplant infection (failure vs infectious complication)
•J96.90: respiratory failure unspecified (transplant-related vs non-transplant respiratory failure)
•Z94.2: lung transplant status (failure vs stable transplant status)
•T86.818: other lung transplant complications (failure vs other specific complications)