What is ICD-10 code T86.812?

T86.812 is the ICD-10-CM diagnosis code for Lung transplant infection. An infection develops in or around the transplanted lung tissue after lung transplant surgery. It belongs to the ICD-10-CM chapter for injury, poisoning and certain other consequences of external causes (s00-t88). T86.812 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. T86.812 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. T86.812 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. T86.812 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 T86.812?

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 T86.812, 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 T86.812?

Use an additional code to identify the specific infectious organism (bacterial, viral, fungal) if documented Note the location of infection (lung tissue, airways, or surrounding areas) for complete clinical documentation Because T86.812 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 T86.812: Lung transplant infection

ICD-10-CM Code View

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Code lookupT86.812Effective 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)

T86.812

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

Lung transplant infection

An infection develops in or around the transplanted lung tissue after lung transplant surgery.

Buddy Insight

Lung transplant infection represents a serious complication in immunocompromised patients that can lead to graft loss and mortality.

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

T86.812Lung transplant infection

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for T86.812 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for T86.812 in this effective period.

Related Child Codes

Official

T86.810Lung transplant rejection

T86.811Lung transplant failure

T86.818Other complications of lung transplant

T86.819Unspecified complication of lung transplant

Includes

Official

ICD-10-CM does not list Includes notes for T86.812 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 T86.812 in this effective period.

Use Additional

Official

code to specify infection

Code Also

Official

ICD-10-CM does not list Code Also instructions for T86.812 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of prior lung transplant procedure

Positive culture results or other microbiologic evidence

Clinical signs and symptoms of infection (fever, increased dyspnea, purulent sputum)

Imaging findings consistent with transplant-related infection

MEAT Support

HCC Buddy guidance

Documentation of prior lung transplant procedure

Positive culture results or other microbiologic evidence

Clinical signs and symptoms of infection (fever, increased dyspnea, purulent sputum)

Imaging findings consistent with transplant-related infection

Audit Caution

HCC Buddy guidance

Using general pneumonia codes without transplant context

Not documenting the causal relationship to immunosuppression

Missing specific pathogen identification in documentation

Failing to differentiate from rejection or other complications

Common Mistakes

HCC Buddy guidance

T86.810 — lung transplant rejection (infectious vs immunologic complication)

T86.811 — lung transplant failure (infection vs overall graft failure)

J18.9 — pneumonia unspecified (transplant-related vs community-acquired pneumonia)

Z87.891 — personal history of nicotine dependence (infection vs risk factor)

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 T86.812 an HCC code?

Yes. T86.812 (Lung transplant infection) 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: T86.812 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: T86.812
Description: Lung transplant infection
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 T86.812 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for T86.812

For T86.812 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 T86.812 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

T86.812 is the ICD-10-CM diagnosis code for lung transplant infection. An infection develops in or around the transplanted lung tissue after lung transplant surgery. T86.812 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, T86.812 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, T86.812 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.

Use an additional code to identify the specific infectious organism (bacterial, viral, fungal) if documented. Because T86.812 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 T86.812 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use an additional code to identify the specific infectious organism (bacterial, viral, fungal) if documented
•Note the location of infection (lung tissue, airways, or surrounding areas) for complete clinical documentation

Clinical Significance

Lung transplant infection represents a serious complication in immunocompromised patients that can lead to graft loss and mortality. These infections often require aggressive treatment and may indicate inadequate immunosuppression balance.

Documentation Requirements

✓Documentation of prior lung transplant procedure
✓Positive culture results or other microbiologic evidence
✓Clinical signs and symptoms of infection (fever, increased dyspnea, purulent sputum)
✓Imaging findings consistent with transplant-related infection
✓Laboratory evidence of infection (elevated WBC, inflammatory markers)
✓Specific pathogen identification when possible
✓Antibiotic or antifungal therapy administration
✓Physician assessment linking infection to transplant status

Use Additional Code

code to specify infection

Commonly Confused Codes

•T86.810: lung transplant rejection (infectious vs immunologic complication)
•T86.811: lung transplant failure (infection vs overall graft failure)
•J18.9: pneumonia unspecified (transplant-related vs community-acquired pneumonia)
•Z87.891: personal history of nicotine dependence (infection vs risk factor)
•T86.818: other lung transplant complications (infection vs other complications)