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T86.818 ICD-10-CM Code: Other complications of lung transplant

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
1 Excludes1 · 21 Excludes2 · 7 use-additional codes
Risk adjustment
CMS-HCC V28: 1 category · CMS-HCC V22 category 186 · RxHCC V08 category 396

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v43, Appendix B.

  • MS-DRG 205 — OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC (MDC 04)
  • MS-DRG 206 — OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC (MDC 04)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Risk Adjustment (CMS-HCC)

Payment categories this diagnosis maps to under CMS-HCC V28, payment year 2026.

  • HCC 276 — Lung Transplant Status/Complications (supersedes HCC 277, HCC 278, HCC 279, HCC 280)

Other models: CMS-HCC V22 HCC 186 · RxHCC V08 HCC 396

Risk scores depend on the enrollee's full accepted diagnosis set and segment; a category mapping alone does not determine payment.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for T86.818 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 T86.818 itself; “inherited from” names the category or block whose note applies here.

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from T86.81

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Use Additional Code

Supplementary codes the tabular list directs you to add.

  • Use additional code to identify other transplant complications, such as:
  • graft-versus-host disease (D89.81-) inherited from T86
  • malignancy associated with organ transplant (C80.2) inherited from T86
  • post-transplant lymphoproliferative disorders (PTLD) (D47.Z1) inherited from T86
  • Use additional code for adverse effect, if applicable, to identify drug (T36-T50 with fifth or sixth character 5) inherited from T80-T88
  • Use additional code(s) to identify the specified condition resulting from the complication inherited from T80-T88
  • Use additional code to identify devices involved and details of circumstances (Y62-Y82) inherited from T80-T88

Coder workflow for T86.818

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

Before you code T86.818

  1. “Other” (NEC) means the condition is specified in the record but no dedicated code captures it. Confirm the documented form is not one a sibling code names before settling on T86.818; if the record states no specifics at all, the unspecified sibling applies instead. “Other” codes are for documented conditions the classification gives no specific code; “unspecified” codes are for records lacking the detail (Guidelines I.A.9.a, I.A.9.b).

    ReviewT86.810, T86.811, T86.812

    See the relationships section · Guide: Other vs unspecified (NEC vs NOS) →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with T86.818. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in T86.818’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewT86.3

Consider T86.818. Then work the Use Additional Code note, and confirm the code is valid for the date of service in the Verify section.

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.
Any detail beyond this code’s title
What the record states that a more specific sibling code would capture — or its absence, which itself supports the unspecified code.

Official instructions as workflow

  • Excludes1 — check before selecting T86.818(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with T86.818: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareT86.3

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

  • Excludes2 — not part of T86.818(21 notes)

    Coding workflow: The conditions named in this note are not included in T86.818. 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 T86.818(7 notes)

    Coding workflow: Check whether the documentation supports the additional code(s) the note names, and report them with T86.818 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

Documentation: Both the condition T86.818 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewT86.3

Documentation: A condition the Use Additional Code note names is documented.

Coding question: Is a second code reported with T86.818?

Path: Review the Use Additional Code note and the code it names.

Reason: The additional code is reported when the record documents the condition; a conditional instruction applies only when its condition is met (Guidelines I.A.13).

ReviewD89.81, C80.2, D47.Z1

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.

Code Overview

Other complications of lung transplant is a billable ICD-10-CM diagnosis code (T86.818).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (1)

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.

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.

Chapter 2: Neoplasms (C00-D49 )

r. Malignant neoplasm associated with transplanted organ A malignant neoplasm of a transplanted organ should be coded as a transplant complication. Assign first the appropriate code from category T86.-, Complications of transplanted organs and tissue, followed by code C80.2, Malignant neoplasm associated with transplanted organ. Use an additional code for the specific malignancy. s. Breast Implant Associated Anaplastic Large Cell Lymphoma Breast implant associated anaplastic large cell lymphoma (BIA-ALCL) is a type of lymphoma that can develop around breast implants. Assign code C84.7A, Anaplastic large cell lymphoma, ALK-negative, breast, for BIA-ALCL or C84.7B, Anaplastic large cell lymphoma, ALK-negative, in remission, for BIA- ALCL in remission. Do not assign a complication code from chapter 19.

Chapter 19: Injury, poisoning, and certain other consequences of external causes (S00-T88)

(a) Transplant complications other than kidney Codes under category T86, Complications of transplanted organs and tissues, are for use for both complications and rejection of transplanted organs. A transplant complication code is only assigned if the complication affects the function of the transplanted organ. Two codes are required to fully describe a transplant complication: the appropriate code from category T86 and a secondary code that identifies the complication.

Decision Points

The directives on this code's own record, as a pre-claim checklist.

  1. 7 Use Additional Code instructions — report the named additional code(s) when the documentation supports them. See the Use Additional Code notes
  2. 1 Excludes1 entry — codes named there are generally not reported together with this code (Guidelines I.A.12.a). See the Excludes1 notes
  3. 21 Excludes2 entries — those conditions are not part of this code and may be reported additionally when documented. See the Excludes2 notes

Checklist rows are derived from this code's own official directives; the wording of each check is MedCoder editorial. The official notes themselves are in the sections each row links to.

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 T86.818 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 2 Excludes1 notes across 2 chapters: 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 45 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 205 (MDC 04), DRG 206 (MDC 04).

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.

H59.819 — Chorioretinal scars after surgery for detachment, unspecified eye, H59.88 — Other intraoperative complications of eye and adnexa, not elsewhere classified, H59.89 — Other postprocedural complications and disorders of eye and adnexa, not elsewhere classified, H95.811 — Postprocedural stenosis of right external ear canal, H95.812 — Postprocedural stenosis of left external ear canal, H95.813 — Postprocedural stenosis of external ear canal, bilateral, 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, T86.810 — Lung transplant rejection, T86.811 — Lung transplant failure, T86.812 — Lung transplant infection, T86.819 — Unspecified complication of lung transplant, +24 more

Same CMS-HCC risk category (V28)

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

J4A.0 — Restrictive allograft syndrome, J4A.8 — Other chronic lung allograft dysfunction, J4A.9 — Chronic lung allograft dysfunction, unspecified, T86.30 — Unspecified complication of heart-lung transplant, T86.31 — Heart-lung transplant rejection, T86.32 — Heart-lung transplant failure, T86.33 — Heart-lung transplant infection, T86.39 — Other complications of heart-lung transplant, T86.810 — Lung transplant rejection, T86.811 — Lung transplant failure, T86.812 — Lung transplant infection, T86.819 — Unspecified complication of lung transplant, Z48.24 — Encounter for aftercare following lung transplant, Z48.280 — Encounter for aftercare following heart-lung transplant, Z94.2 — Lung transplant status, Z94.3 — Heart and lungs transplant status

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).

T86.39 — 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, T86.811 — Lung transplant failure, T86.812 — Lung transplant infection, T86.819 — Unspecified complication of lung transplant, T86.820 — Skin graft (allograft) rejection, T86.821 — Skin graft (allograft) (autograft) failure, T86.822 — Skin graft (allograft) (autograft) infection, T86.828 — Other complications of skin graft (allograft) (autograft), T86.829 — Unspecified complication of skin graft (allograft) (autograft), T86.830 — Bone graft rejection, T86.831 — Bone graft failure, T86.832 — Bone graft infection, T86.838 — Other complications of bone graft, +76 more

Contextual Map

Every relationship of T86.818 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 T86.818 with these 16 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Referenced by Code First instructions

Clinical classification (CCSR)

Risk adjustment (CMS-HCC)

  • 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

MDC crossing

  • MDC 04 — Diseases and Disorders of the Respiratory System[MDC crossing]: “Diseases and Disorders of the Respiratory 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. 3,998 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2026

Index entries

  • Complication (s) (from) (of), transplant, lung, specified type NEC[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (40)

Change history

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

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

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Other complications of lung transplant

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027 (effective October 1, 2026), and none are recorded for this code. Note changes are tracked from FY2027 only.

Nearest Codes in This Family

Official ICD-10-CM classifications closest to T86.818 in its code family, with their registry titles.

View all codes in the T86 family