What is ICD-10 code T86.819?

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 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. T86.819 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. T86.819 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. T86.819 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.

Which HCC does T86.819 map to under V28?

T86.819 maps to CMS-HCC V28 276 (Lung Transplant Status/Complications). The category number and label come from the CMS-HCC V28 model file for payment year 2026.

What does T86.819 pay in RAF?

T86.819 carries a community, non-dual, aged (CNA) RAF weight of 2.531 under CMS-HCC V28 for payment year 2026. The weight comes from the CMS V28 relative-factor file, not a hand-typed table.

What is the V28 vs V24 difference for T86.819?

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 T86.819, 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 documentation supports T86.819?

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 Because T86.819 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. See the MEAT criteria checklist at /meat-criteria for what Monitor, Evaluate, Assess, or Treat looks like in a note. MEAT is generic documentation evidence, not a payer-specific rule.

2026 ICD-10-CM T86.819: Unspecified

T86.819 maps to CMS-HCC V28 276 (RAF 2.531). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools

ICD-10-CM Code View

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Code lookupT86.819Effective 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)

T86.819

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

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.

Buddy Insight

Unspecified lung transplant complications indicate documented transplant-related problems without specific identification of the complication type.

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

T86.819Unspecified complication of lung transplant

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for T86.819 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for T86.819 in this effective period.

Related Child Codes

Official

T86.810Lung transplant rejection

T86.811Lung transplant failure

T86.812Lung transplant infection

T86.818Other complications of lung transplant

Includes

Official

ICD-10-CM does not list Includes notes for T86.819 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 T86.819 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for T86.819 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for T86.819 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

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

MEAT Support

HCC Buddy guidance

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

Audit Caution

HCC Buddy guidance

Using when more specific codes are supported by documentation

Applying to normal post-transplant monitoring visits

Not establishing clear relationship between symptoms and transplant

Using for routine transplant surveillance without complications

Common Mistakes

HCC Buddy guidance

Z94.2 — lung transplant status (complication present vs stable status)

T86.818 — other lung transplant complications (unspecified vs specified other)

T86.810-T86.812 — specific lung transplant complications (unspecified vs specific types)

J98.4 — other disorders of lung (transplant vs non-transplant lung disorder)

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 T86.819 an HCC code?

Yes. T86.819 (Unspecified complication of lung transplant) 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: T86.819 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: T86.819
Description: Unspecified complication of lung transplant
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 T86.819 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

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.

Coder workflow notes

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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 2.531. 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 0.832. 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.

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

Commonly Confused Codes

•Z94.2: lung transplant status (complication present vs stable status)
•T86.818: other lung transplant complications (unspecified vs specified other)
•T86.810-T86.812: specific lung transplant complications (unspecified vs specific types)
•J98.4: other disorders of lung (transplant vs non-transplant lung disorder)
•R06.02: shortness of breath (symptom vs transplant complication)