T86.31 ICD-10-CM Code: Heart-lung transplant rejection

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for T86.31 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2026Effective: October 1, 2025

Notes without a marker are published on T86.31 itself; “inherited from” names the category or block whose note applies here.

Coder workflow for T86.31

MedCoder structured workflow — derived from this code’s own official record

Documentation check

The provider’s diagnostic statement

Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

The conditions the Use Additional Code note names

Reported with this code when documented; a conditional instruction (“if applicable”, “if known”) applies only when the record supports it.

Official instructions as workflow

• Excludes2 — not part of T86.31(21 notes)

  Coding workflow: The conditions named in this note are not included in T86.31. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

  CompareZ93, Z43, Z44, R50.82, G97.0, K94.0

  See the official tabular notes · Guidelines I.A.12.b

• Use Additional Code — after identifying T86.31(7 notes)

  Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with T86.31 when it does. Where the instruction is conditional (“if applicable”, “if known”), it applies only when the record documents the condition.

  ReviewD89.81, C80.2, D47.Z1

  See the official tabular notes · Guidelines I.A.13

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Indexed Clinical Terms (4)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

• Complication (s) (from) (of), transplant, heart, cardiac allograft vasculopathy, rejection
• Complication (s) (from) (of), transplant, lung, with heart, rejection
• Rejection, transplant, heart, with lung (s)
• Rejection, transplant, lung (s), with heart

Official Coding Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Official source data — quoted verbatim from the CMS/NCHS Official Guidelines

Verbatim excerpts from the ICD-10-CM Official Guidelines for Coding and Reporting (CMS/NCHS) that govern this code.

Don’t confuse T86.31 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of T86.31 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

• T86.30— Specificity relationship (Review)

  Overlapping diagnoses in the same category.

  Overlapping codes in the same category — the documentation decides which is the more specific fit.

  What moves you there: A record that documents no more than “Unspecified complication of heart-lung transplant” takes T86.30; specificity in the record moves it back here.

  Full comparison: T86.31 vs T86.30 →

• Z93— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of artificial opening status adds Z93; it is not part of this code and both may be reported when both are documented.

  Full comparison: T86.31 vs Z93 →

• Z43— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of closure of external stoma adds Z43; it is not part of this code and both may be reported when both are documented.

  Full comparison: T86.31 vs Z43 →

• Z44— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of fitting and adjustment of external prosthetic device adds Z44; it is not part of this code and both may be reported when both are documented.

  Full comparison: T86.31 vs Z44 →

• T20— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of burns and corrosions from local applications and irradiation adds T20; it is not part of this code and both may be reported when both are documented.

  Full comparison: T86.31 vs T20 →

• T32— Excludes2 relationship (Informational)

  Distinct conditions — both may be reported.

  A distinct condition — both may be reported when both are documented.

  What moves you there: Documentation of burns and corrosions from local applications and irradiation adds T32; it is not part of this code and both may be reported when both are documented.

  Full comparison: T86.31 vs T32 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Verify Before Coding

• CC as a secondary diagnosis (FY2026). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name T86.31 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 4 Excludes1 notes across 2 chapters: T86.2 — Complications of heart transplant (via T86.3.-), T86.81 — Complications of lung transplant (via T86.3.-), T88.7 — Unspecified adverse effect of drug or medicament (via T86.-), Z98.85 — Transplanted organ removal status (via T86.-).

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 8 Excludes2 notes across 2 chapters: D89 — Other disorders involving the immune mechanism, not elsewhere classified (via T86.-), T78 — Adverse effects, not elsewhere classified (via T86.-), T79 — Certain early complications of trauma, not elsewhere classified (via T86.-), T81 — Complications of procedures, not elsewhere classified (via T86.-), T82 — Complications of cardiac and vascular prosthetic devices, implants and grafts (via T86.-), T83 — Complications of genitourinary prosthetic devices, implants and grafts (via T86.-), T84 — Complications of internal orthopedic prosthetic devices, implants and grafts (via T86.-), T85 — Complications of other internal prosthetic devices, implants and grafts (via T86.-).

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 6 Code First instructions across 3 chapters: C80.2 — Malignant neoplasm associated with transplanted organ (via T86.-), D47.Z1 — Post-transplant lymphoproliferative disorder (PTLD) (via T86.-), D89.81 — Graft-versus-host disease (via T86.-), D89.83 — Cytokine release syndrome (via T86.-), J44.81 — Bronchiolitis obliterans and bronchiolitis obliterans syndrome, J4A — Chronic lung allograft dysfunction.

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

MS-DRG Grouper Relationships (FY2026)

Potential MS-DRG participation — not a DRG assignment.

FY2026 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 51 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 3 MS-DRGs: DRG 314 (MDC 05), DRG 315 (MDC 05), DRG 316 (MDC 05).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):INJ036 — Complication of transplanted organs or tissue, initial encounter (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

H95.819 — Postprocedural stenosis of unspecified external ear canal, H95.88 — Other intraoperative complications and disorders of the ear and mastoid process, not elsewhere classified, H95.89 — Other postprocedural complications and disorders of the ear and mastoid process, not elsewhere classified, I97.3 — Postprocedural hypertension, M96.89 — Other intraoperative and postprocedural complications and disorders of the musculoskeletal system, N98.1 — Hyperstimulation of ovaries, N98.2 — Complications of attempted introduction of fertilized ovum following in vitro fertilization, N98.3 — Complications of attempted introduction of embryo in embryo transfer, N98.8 — Other complications associated with artificial fertilization, N98.9 — Complication associated with artificial fertilization, unspecified, T86.20 — Unspecified complication of heart transplant, T86.21 — Heart transplant rejection, T86.22 — Heart transplant failure, T86.23 — Heart transplant infection, T86.290 — Cardiac allograft vasculopathy, T86.298 — Other complications of heart transplant, T86.30 — Unspecified complication of heart-lung transplant, T86.32 — Heart-lung transplant failure, T86.33 — Heart-lung transplant infection, T86.39 — Other complications of heart-lung transplant, +30 more

Same CMS-HCC risk category (V28)

CMS maps these diagnoses to the same Hierarchical Condition Categories (Heart Transplant Status/Complications, Lung Transplant Status/Complications) for risk-adjusted payment.

J4A.0 — Restrictive allograft syndrome (Lung Transplant Status/Complications), J4A.8 — Other chronic lung allograft dysfunction (Lung Transplant Status/Complications), J4A.9 — Chronic lung allograft dysfunction, unspecified (Lung Transplant Status/Complications), T86.20 — Unspecified complication of heart transplant (Heart Transplant Status/Complications), T86.21 — Heart transplant rejection (Heart Transplant Status/Complications), T86.22 — Heart transplant failure (Heart Transplant Status/Complications), T86.23 — Heart transplant infection (Heart Transplant Status/Complications), T86.290 — Cardiac allograft vasculopathy (Heart Transplant Status/Complications), T86.298 — Other complications of heart transplant (Heart Transplant Status/Complications), T86.30 — Unspecified complication of heart-lung transplant (Heart Transplant Status/Complications), T86.32 — Heart-lung transplant failure (Heart Transplant Status/Complications), T86.33 — Heart-lung transplant infection (Heart Transplant Status/Complications), T86.39 — Other complications of heart-lung transplant (Heart Transplant Status/Complications), T86.810 — Lung transplant rejection (Lung Transplant Status/Complications), T86.811 — Lung transplant failure (Lung Transplant Status/Complications), T86.812 — Lung transplant infection (Lung Transplant Status/Complications), T86.818 — Other complications of lung transplant (Lung Transplant Status/Complications), T86.819 — Unspecified complication of lung transplant (Lung Transplant Status/Complications), Z48.21 — Encounter for aftercare following heart transplant (Heart Transplant Status/Complications), Z48.24 — Encounter for aftercare following lung transplant (Lung Transplant Status/Complications), +4 more

Related risk categories

These categories interact through CMS's HCC hierarchy — one can suppress the other's risk-adjustment weight when both are present on a claim.

Cystic Fibrosis, Idiopathic Pulmonary Fibrosis and Lung Involvement in Systemic Sclerosis, Severe Persistent Asthma, Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Complication of transplanted organs or tissue, initial encounter).

T86.12 — Kidney transplant failure, T86.13 — Kidney transplant infection, T86.19 — Other complication of kidney transplant, T86.20 — Unspecified complication of heart transplant, T86.21 — Heart transplant rejection, T86.22 — Heart transplant failure, T86.23 — Heart transplant infection, T86.290 — Cardiac allograft vasculopathy, T86.298 — Other complications of heart transplant, T86.30 — Unspecified complication of heart-lung transplant, T86.32 — Heart-lung transplant failure, T86.33 — Heart-lung transplant infection, T86.39 — Other complications of heart-lung transplant, T86.40 — Unspecified complication of liver transplant, T86.41 — Liver transplant rejection, T86.42 — Liver transplant failure, T86.43 — Liver transplant infection, T86.49 — Other complications of liver transplant, T86.5 — Complications of stem cell transplant, T86.810 — Lung transplant rejection, +76 more

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main term “Rejection”; these codes share that main term but sit in a different category of the Tabular List.

F50.89 — Other specified eating disorder

Contextual Map

Every relationship of T86.31 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run T86.31 with these 18 related codes in Claim Check

Hierarchy

• S00-T88 — Chapter 19: Injury, Poisoning and Certain Other Consequences of External Causes (S00-T88) (S00-T88)[Hierarchy]— CMS ICD-10-CM tabular structure · icd10cm-fy2026

Referenced by Excludes1 notes

• T86.2 — Complications of heart transplant[Excludes1](via T86.3.-): “heart-lung transplant (T86.3-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T86.81 — Complications of lung transplant[Excludes1](via T86.3.-): “complication of heart-lung transplant (T86.3-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T88.7 — Unspecified adverse effect of drug or medicament[Excludes1](via T86.-): “specified adverse effects of drugs and medicaments (A00-R94 and T80-T88.6, T88.8)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• Z98.85 — Transplanted organ removal status[Excludes1](via T86.-): “encounter for removal of transplanted organ -code to complication of transplanted organ (T86.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Excludes2 notes

• D89 — Other disorders involving the immune mechanism, not elsewhere classified[Excludes2](via T86.-): “transplant failure and rejection (T86.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T78 — Adverse effects, not elsewhere classified[Excludes2](via T86.-): “complications of surgical and medical care NEC (T80-T88)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T79 — Certain early complications of trauma, not elsewhere classified[Excludes2](via T86.-): “complications occurring during or following medical procedures (T80-T88)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T81 — Complications of procedures, not elsewhere classified[Excludes2](via T86.-): “complications of transplanted organs and tissue (T86.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T82 — Complications of cardiac and vascular prosthetic devices, implants and grafts[Excludes2](via T86.-): “failure and rejection of transplanted organs and tissue (T86.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T83 — Complications of genitourinary prosthetic devices, implants and grafts[Excludes2](via T86.-): “failure and rejection of transplanted organs and tissue (T86.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T84 — Complications of internal orthopedic prosthetic devices, implants and grafts[Excludes2](via T86.-): “failure and rejection of transplanted organs and tissues (T86.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• T85 — Complications of other internal prosthetic devices, implants and grafts[Excludes2](via T86.-): “failure and rejection of transplanted organs and tissue (T86.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Referenced by Code First instructions

• C80.2 — Malignant neoplasm associated with transplanted organ[Code First](via T86.-): “complication of transplanted organ (T86.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• D47.Z1 — Post-transplant lymphoproliferative disorder (PTLD)[Code First](via T86.-): “complications of transplanted organs and tissue (T86.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• D89.81 — Graft-versus-host disease[Code First](via T86.-): “complications of transplanted organs and tissue (T86.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• D89.83 — Cytokine release syndrome[Code First](via T86.-): “complications of transplanted organs and tissue (T86.-)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• J44.81 — Bronchiolitis obliterans and bronchiolitis obliterans syndrome[Code First]: “heart-lung transplant rejection (T86.31)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026
• J4A — Chronic lung allograft dysfunction[Code First]: “heart-lung transplant rejection (T86.31)”— CMS ICD-10-CM tabular instructional notes · icd10cm-fy2026

Clinical classification (CCSR)

• INJ036 — Complication of transplanted organs or tissue, initial encounter[CCSR]— AHRQ CCSR for ICD-10-CM Diagnoses (HCUP)

Risk adjustment (CMS-HCC)

• HCC 221 — Heart Transplant Status/Complications [CMS-HCC]— CMS-HCC V28 · 2026
• HCC 276 — Lung Transplant Status/Complications [CMS-HCC]: “Lung Transplant Status/Complications — supersedes HCC 277 (Cystic Fibrosis), HCC 278 (Idiopathic Pulmonary Fibrosis and Lung Involvement in Systemic Sclerosis), HCC 279 (Severe Persistent Asthma), HCC 280 (Chronic Obstructive Pulmonary Disease, Interstitial Lung Disorders, and Other Chronic Lung Disorders)”— CMS-HCC V28 · 2026

MS-DRG Grouper

• CC — Complication or Comorbidity [MS-DRG severity]: “As a secondary diagnosis this code can raise the stay's MS-DRG severity tier (CC).”— CMS MS-DRG Definitions Manual (Appendix C) · FY2026
• DRG 314 — OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC[MS-DRG]: “OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC (MDC 05)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 315 — OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC[MS-DRG]: “OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC (MDC 05)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026
• DRG 316 — OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC[MS-DRG]: “OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC (MDC 05)”— CMS MS-DRG Definitions Manual (Appendix B) · FY2026

MDC crossing

• MDC 05 — Diseases and Disorders of the Circulatory System[MDC crossing]: “Diseases and Disorders of the Circulatory System — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 17,209 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

• Complication (s) (from) (of), transplant, heart, cardiac allograft vasculopathy, rejection[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Complication (s) (from) (of), transplant, lung, with heart, rejection[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Rejection, transplant, heart, with lung (s)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026
• Rejection, transplant, lung (s), with heart[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (40)

• T86 — Complications of transplanted organs and tissue[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T86.01 — Bone marrow transplant rejection[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T86.02 — Bone marrow transplant failure[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T86.03 — Bone marrow transplant infection[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T86.09 — Other complications of bone marrow transplant[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T86.1 — Complications of kidney transplant[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T86.10 — Unspecified complication of kidney transplant[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• T86.11 — Kidney transplant rejection[Sibling]— CMS ICD-10-CM tabular structure · icd10cm-fy2026
• and 32 more

Change history

• FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Relevant guides

• Transplant Complication or Transplant Status? T86 vs Z94, and CKD After a Kidney Transplant →

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data

CMS/CDC ICD-10-CM FY2026 tabular list, index and tables, effective October 1, 2025 Release, file and checksum · Publisher’s page

Coding guidelines Official source data

ICD-10-CM Official Guidelines for Coding and Reporting (FY2026), quoted by section Release, file and checksum · Publisher’s page

Claim edits Official source data

CMS Definitions of Medicare Code Edits — v43.1 (April 2026) Release, file and checksum · Publisher’s page

Inpatient payment groups Official source data

CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v43 Release, file and checksum · Publisher’s page

Risk adjustment Official source data

2026 Mid-Year Final ICD-10 Mappings + Model Software (cms.gov/files/zip/2026-midyear-final-icd-10-mappings.zip, 2026-midyear-final-model-software.zip) — CMS-HCC V28, PY2026 mid-year final release Release, file and checksum · Publisher’s page

Change history and date-of-service validity Official source data

CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page

Comparisons, relationships and the contextual map MedCoder structured relationship

Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears

Summary and FAQ answers MedCoder explanation

Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Nearest Codes in This Family

Official ICD-10-CM classifications closest to T86.31 in its code family, with their registry titles.

• T86.29 — Other complications of heart transplant
• T86.290 — Cardiac allograft vasculopathy
• T86.298 — Other complications of heart transplant
• T86.3 — Complications of heart-lung transplant
• T86.30 — Unspecified complication of heart-lung transplant
• T86.32 — Heart-lung transplant failure
• T86.33 — Heart-lung transplant infection
• T86.39 — Other complications of heart-lung transplant
• T86.4 — Complications of liver transplant
• T86.40 — Unspecified complication of liver transplant

View all codes in the T86 family