Z94.3: Heart and lungs transplant status
Z94.3 is a billable, specific ICD-10-CM code for heart and lungs transplant status. It is valid for submission on a claim.
Check Z94.3 with the rest of the claim: free scrubberExcludes1 inherited from the categories above Z94.3
A category’s note binds every code beneath it.
Written on Z94: Transplanted organ and tissue status
- complications of transplanted organ or tissue - see Alphabetical Index
Excludes2 inherited from the categories above Z94.3
Not part of this code, but both may be coded when both are present.
Other codes that can never be billed with Z94.3
Their own Excludes1 notes name this code, so the conflict is not listed above.
- Z18Retained foreign body fragments
Risk adjustment
Z94.3 risk-adjusts. Under the CMS-HCC V28 model it maps to these categories:
- HCC 221 Heart Transplant Status/Complications1.053 RAF
- HCC 276 Lung Transplant Status/Complications2.531 RAF
Coefficient shown for the Community Non-dual Aged segment. A higher HCC in the same hierarchy will suppress this one, so capturing it does not always add score. Look up the whole chart to see which of its HCCs the hierarchy would zero.
Medicare coverage
Z94.3 is named in 33 Medicare coverage policies: 33 listing it as supporting medical necessity. Which one applies depends on your Medicare contractor.
- A52474Immunosuppressive Drugs - Policy Article
- A52850Billing and Coding: Cardiac Catheterization and Coronary Angiography
- A52868Billing and Coding: Transesophageal Echocardiography (TEE)
- A53775Billing and Coding: Frequency and Duration for Cardiac Rehabilitation and Intensive Cardiac Rehabilitation
Alphabetic index entries that lead here
- Transplant›heart›and lung(s)
- Transplant›lung›and heart
The condition this code belongs to
Code history
Unchanged in every release from FY2024 to FY2027.