T86.851
BillableIntestine transplant failure
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T86.851 an HCC code?
Yes. T86.851 maps to Intestine 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 T86.851
For T86.851 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 T86.851 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
T86.851 is the ICD-10-CM diagnosis code for intestine transplant failure. A transplanted intestine stops functioning properly or ceases to work, regardless of the cause. T86.851 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, T86.851 maps to Intestine Transplant Status/Complications (HCC 77) with a community, non-dual, aged base RAF weight of 0.000. Under the older CMS-HCC V24 model, T86.851 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 this code when intestinal transplant failure is documented but rejection is not the documented cause. Because T86.851 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 T86.851 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code when intestinal transplant failure is documented but rejection is not the documented cause
- •Distinguish between rejection (T86.850) and failure (T86.851) based on clinical documentation
Clinical Significance
Intestinal transplant failure indicates severe graft dysfunction that may be irreversible, representing a life-threatening condition requiring intensive management and possible retransplantation consideration. This diagnosis carries extremely high mortality risk.
Documentation Requirements
- ✓Documentation of intestinal transplant history
- ✓Evidence of graft failure (biopsy, imaging, functional studies)
- ✓Clinical manifestations of failure (malabsorption, diarrhea, nutritional deficiencies)
- ✓Laboratory evidence of graft dysfunction
- ✓Nutritional assessment and requirements
- ✓Provider assessment confirming transplant failure
- ✓Current management including nutritional support
- ✓Consideration for retransplantation evaluation
Commonly Confused Codes
- •T86.850 — intestine transplant rejection (failure vs specific rejection)
- •T86.852 — intestine transplant infection (failure vs infectious complication)
- •K91.2 — postsurgical malabsorption (transplant failure vs surgical malabsorption)
- •Z94.82 — intestine transplant status (failure vs stable status)
- •T86.858 — other intestine transplant complications (failure vs other complications)