Z94.2 ICD-10-CM Code: Lung transplant status
Z94.2 maps to CMS-HCC V28 276. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software
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FY 2026 Apr update / Factors influencing health status and contact with health services (Z00-Z99) / Persons with potential health hazards related to family and personal history and certain conditions influencing health status (Z77-Z99)
Z94.2
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceLung transplant status
A person who has received a lung transplant and the transplant is currently functioning.
Buddy Insight
This code represents successful lung transplantation with current organ function, indicating survival from end-stage pulmonary disease but requiring lifelong immunosuppressive therapy and pulmonary monitoring.
CMS-HCC V28
MappedHCC 276
Coefficient HCC 276: 2.531 (Community Non-Dual Aged (CNA))
CMS-HCC V24
HistoricalHistorical
Not used for CY2026 payment
ACA/HHS
MappedHCC 158
Code-level coefficient reference
ESRD/PACE
MappedHCC 186
Code-level coefficient reference
RXHCC
MappedHCC 396
Code-level coefficient reference
Code Book Path
Inclusion Terms
OfficialNo inclusion terms are included in this display for Z94.2. Check the code and parent instructions in the Code Book.
Excludes 2
Official- presence of vascular grafts (Z95.-)Inherited from Z94
Related Codes
Includes
Official- organ or tissue replaced by heterogenous or homogenous transplantInherited from Z94
Excludes 1
Official- complications of transplanted organ or tissue - see Alphabetical IndexInherited from Z94
Code First
OfficialNo Code First sequencing instructions are included in this display for Z94.2. Check the code and parent instructions in the Code Book.
Use Additional
OfficialNo Use Additional Code instructions are included in this display for Z94.2. Check the code and parent instructions in the Code Book.
Code Also
Official- any follow-up examination (Z08-Z09)Inherited from Z77-Z99
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 Z94.2 an HCC code?
Yes. Z94.2 (Lung transplant status) maps to HCC 276, Lung Transplant Status/Complications under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 2.531. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.
Coder answer: Z94.2 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
- Z94.2
- Description
- Lung transplant status
- HCC (V28)
- HCC 276 — Lung Transplant Status/Complications
- RAF reference coefficient
- 2.531
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.
Work Z94.2 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →
MEAT review for Z94.2
For Z94.2, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.
- 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
Coder workflow notes
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What This Code Means
Z94.2 is the ICD-10-CM diagnosis code for lung transplant status. A person who has received a lung transplant and the transplant is currently functioning. Z94.2 sits in the ICD-10-CM chapter for factors influencing health status and contact with health services (z00-z99), within the section covering persons with potential health hazards related to family and personal history and certain conditions influencing health status (z77-z99).
Under the CMS-HCC V28 risk adjustment model, Z94.2 maps to Lung Transplant Status/Complications (HCC 276) with a source-labeled community, non-dual, aged reference coefficient of 2.531. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.
Lung transplant status, post-lung-transplant with functioning allograft. Single or bilateral lung transplant both code here; specify further when needed. For Z94.2, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for Z94.2 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Lung transplant status, post-lung-transplant with functioning allograft. Single or bilateral lung transplant both code here; specify further when needed.
- •Lung-transplant recipients face high rates of chronic rejection and complications; watch for T86.81x (lung transplant complications) documentation.
Clinical Significance
This code represents successful lung transplantation with current organ function, indicating survival from end-stage pulmonary disease but requiring lifelong immunosuppressive therapy and pulmonary monitoring. These patients have ongoing high infection risk and complex respiratory management needs.
Documentation Requirements
- ✓Confirmation of functioning lung transplant
- ✓Single vs bilateral lung transplant
- ✓Date of transplant if available
- ✓Current pulmonary function tests
- ✓Immunosuppressive medication regimen
- ✓Routine monitoring including bronchoscopy
- ✓No current rejection or complications
- ✓Pulmonary transplant follow-up care