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Z94.2 ICD-10-CM Code: Lung transplant status

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

Coding at a Glance

Tabular directives
1 inclusion term · 1 Excludes1 · 1 Excludes2 · 1 code-also instruction
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 Z94.2 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 Z94.2 itself; “inherited from” names the category or block whose note applies here.

Includes

Conditions the official ICD-10-CM tabular list includes under this code.

  • organ or tissue replaced by heterogenous or homogenous transplant

Source: inherited from Z94

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).

  • complications of transplanted organ or tissue - see Alphabetical Index

Source: inherited from Z94

Excludes2 — Not Included Here

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

Source: inherited from Z94

Code Also

Additional codes that may be required to fully describe the encounter.

  • any follow-up examination (Z08-Z09)

Source: inherited from Z77-Z99

Coder workflow for Z94.2

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

Before you code Z94.2

  1. Confirm the reason for the encounter this Z code records: a status — a condition, carrier state or sequela that may affect care, distinct from a current complication of it. Check whether the code may be reported as first-listed or principal — some Z codes are limited to one position — and do not report a history or status code for a condition documented as current. Z code categories and their reporting positions (Guidelines I.C.21.c.3, I.C.21.c.15).

    Guide: Status codes (Z codes) →

  2. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with Z94.2. 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 Z94.2’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.

Consider Z94.2. Then review the Code Also 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 reason for the encounter
Whether the code records the encounter’s purpose, a status, or a history — and whether it may be first-listed (Guidelines I.C.21.c).

Official instructions as workflow

  • Excludes1 — check before selecting Z94.2(1 note)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with Z94.2: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

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

  • Excludes2 — not part of Z94.2(1 note)

    Coding workflow: The conditions named in this note are not included in Z94.2. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareZ95

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

  • Code Also — related condition(1 note)

    Coding workflow: Review the related condition when both are documented and the instruction applies. A Code Also note does not fix sequencing; the order follows the circumstances of the encounter.

    See the official tabular notes · Guidelines I.A.17

Coding decision scenarios

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

Documentation: Both the condition Z94.2 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).

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

Lung transplant status is a billable ICD-10-CM diagnosis code (Z94.2).

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 21: Factors influencing health status and contact with health services (Z00-Z99)

Code Z92.82 is only applicable to the receiving facility record and not to the transferring facility record. Z93 Artificial opening status Z94 Transplanted organ and tissue status Z95 Presence of cardiac and vascular implants and grafts Z96 Presence of other functional implants Z97 Presence of other devices Z98 Other postprocedural states Assign code Z98.85, Transplanted organ removal status, to indicate that a transplanted organ has been previously removed. This code should not be assigned for the encounter in which the transplanted organ is removed. The complication necessitating removal of the transplant organ should be assigned for that encounter.

Decision Points

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

  1. 1 Code Also note — a second code may apply; the guidelines leave its sequencing to the circumstances of the encounter. See the Code Also 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. 1 Excludes2 entry — 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

  • Principal-diagnosis restriction. The Medicare Code Editor lists this code as unacceptable as a principal diagnosis: it describes a circumstance influencing health status rather than a current illness or injury being treated. It is valid as a secondary diagnosis.
  • 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 Z94.2 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 1 Excludes1 note: Z18 — Retained foreign body fragments (via Z94.-).

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

Referenced by 2 Excludes2 notes: Z78 — Other specified health status (via Z94.-), Z87.7 — Personal history of (corrected) congenital malformations (via Z94.-).

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

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 15 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):FAC023 — Organ transplant status (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.

T86.810 — Lung transplant rejection, T86.811 — Lung transplant failure, T86.812 — Lung transplant infection, T86.818 — Other complications of lung transplant, T86.819 — Unspecified complication of lung transplant, T86.850 — Intestine transplant rejection, T86.851 — Intestine transplant failure, T86.852 — Intestine transplant infection, T86.858 — Other complications of intestine transplant, T86.859 — Unspecified complication of intestine transplant, T86.90 — Unspecified complication of unspecified transplanted organ and tissue, T86.91 — Unspecified transplanted organ and tissue rejection, T86.92 — Unspecified transplanted organ and tissue failure, T86.93 — Unspecified transplanted organ and tissue infection, T86.99 — Other complications of unspecified transplanted organ and tissue

Principal diagnosis restriction (Medicare Code Editor)

Not acceptable as a principal diagnosis on an inpatient claim.

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, T86.818 — Other complications of lung transplant, T86.819 — Unspecified complication of lung transplant, Z48.24 — Encounter for aftercare following lung transplant, Z48.280 — Encounter for aftercare following heart-lung transplant, Z94.3 — 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 (Organ transplant status).

Z94.0 — Kidney transplant status, Z94.1 — Heart transplant status, Z94.3 — Heart and lungs transplant status, Z94.4 — Liver transplant status, Z94.5 — Skin transplant status, Z94.6 — Bone transplant status, Z94.7 — Corneal transplant status, Z94.81 — Bone marrow transplant status, Z94.82 — Intestine transplant status, Z94.83 — Pancreas transplant status, Z94.84 — Stem cells transplant status, Z94.89 — Other transplanted organ and tissue status, Z94.9 — Transplanted organ and tissue status, unspecified, Z98.85 — Transplanted organ removal status

Same Index main term, other category

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

Z60.3 — Acculturation difficulty (social), Z76.82 — Awaiting organ transplant status (candidate), Z95.2 — Presence of prosthetic heart valve (heart, valve), Z95.3 — Presence of xenogenic heart valve (heart, valve, xenogenic), Z95.4 — Presence of other heart-valve replacement (heart, valve, specified NEC), Z98.85 — Transplanted organ removal status (organ, removal status)

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Prothrombin Time Test and INR (PT/INR)

Contextual Map

Every relationship of Z94.2 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 Z94.2 with these 3 related codes in Claim Check

Hierarchy

Referenced by Excludes1 notes

Referenced by Excludes2 notes

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

  • Transplant (ed) (status), lung (s)[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2026

Nearest codes (15)

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

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "Z94.2 — Lung transplant status." ICD-10-CM FY2026. https://medcoder.ai/icd10/code/z94.2-lung-transplant-status

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Lung transplant status

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 Z94.2 in its code family, with their registry titles.

View all codes in the Z94 family