T86.819
BillableUnspecified complication of lung transplant
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T86.819 an HCC code?
Yes. T86.819 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 T86.819
For T86.819 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 T86.819 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
T86.819 is the ICD-10-CM diagnosis code for unspecified complication of lung transplant. A complication of lung transplant is documented but the specific type is not identified or specified in the medical record. T86.819 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, T86.819 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, T86.819 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.
This is a default code; query the provider if the specific complication can be determined from clinical documentation. Because T86.819 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 T86.819 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This is a default code; query the provider if the specific complication can be determined from clinical documentation
- •Use only when insufficient information is available to assign a more specific lung transplant complication code
Clinical Significance
Unspecified lung transplant complications indicate documented transplant-related problems without specific identification of the complication type. While less specific, this diagnosis still represents significant risk requiring ongoing monitoring and specialized care.
Documentation Requirements
- ✓Documentation of lung transplant procedure and date
- ✓Evidence of transplant-related complication without specific type identification
- ✓Clinical symptoms or findings suggesting complication
- ✓Exclusion of normal post-transplant status
- ✓Provider assessment acknowledging complication presence
- ✓Treatment or monitoring plans in place
- ✓Rationale for why specific complication type cannot be determined
- ✓Follow-up plans for further evaluation