T86.812
BillableLung transplant infection
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T86.812 an HCC code?
Yes. T86.812 maps to Lung Transplant Status/Complications under the CMS-HCC V28 risk adjustment model (and Major Organ Transplant or Replacement Status under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. 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.
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.
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 0.193. 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 0.910. 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