T86.858
BillableOther complications of intestine transplant
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is T86.858 an HCC code?
Yes. T86.858 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 T86.858
For T86.858 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 T86.858 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
T86.858 is the ICD-10-CM diagnosis code for other complications of intestine transplant. Various other problems or complications develop after an intestinal transplant, excluding rejection, failure, and infection. T86.858 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, T86.858 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, T86.858 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 for complications such as bleeding, anastomotic strictures, or other non-rejection/non-infection issues. Because T86.858 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 T86.858 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code for complications such as bleeding, anastomotic strictures, or other non-rejection/non-infection issues
- •Document the specific nature of the complication in the medical record for clarity and potential future reference
Clinical Significance
Other intestinal transplant complications include various non-rejection, non-failure, non-infectious complications such as anastomotic strictures, bleeding, or lymphoproliferative disorders. These complications require specialized management and significantly impact patient outcomes.
Documentation Requirements
- ✓Documentation of intestinal transplant history
- ✓Specific identification of the complication type
- ✓Clinical evidence supporting the complication
- ✓Exclusion of rejection, failure, and infection
- ✓Diagnostic studies confirming the complication
- ✓Treatment plan for the specific complication
- ✓Provider assessment confirming transplant-related etiology
- ✓Impact on graft function and patient status
Commonly Confused Codes
- •T86.850-T86.852 — specific intestine transplant complications (other vs specific types)
- •K91.89 — other postprocedural complications (transplant vs surgical complications)
- •T86.859 — unspecified intestine transplant complication (other specified vs unspecified)
- •Z94.82 — intestine transplant status (complications vs stable status)
- •K63.9 — disease of intestine unspecified (transplant vs native bowel disease)