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ICD-10-CM Z94.3: Heart and lungs transplant status

Z94.3 is the billable ICD-10-CM code for heart and lungs transplant status, in category Z94 (Transplanted organ and tissue status) of the Persons with potential health hazards related to family and personal history and certain conditions influencing health status section. As a principal diagnosis it groups to MS-DRG 314 Other Circulatory System Diagnoses with MCC, MS-DRG 315 Other Circulatory System Diagnoses with CC, MS-DRG 316 Other Circulatory System Diagnoses without CC/MCC (MDC 05 MDC 05: Diseases and Disorders of the Circulatory System). It maps to HCC 221 (Heart Transplant Status/Complications) and HCC 276 (Lung Transplant Status/Complications) in CMS-HCC V28. As a secondary diagnosis it is a CC, excluded with 21 principal diagnoses. 33 LCD billing and coding articles list it as covered.

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: ICD-10-CM code descriptions: FY2027 (effective October 1, 2026); IPPS Table 5 (MS-DRG weights): v44 FY2027 (final rule + CN3) (effective October 1, 2026); ICD-10-CM to HCC mapping: PY2027 initial ICD-10-CM mappings (dates of service 2026) (payment year 2027); Medicare Coverage Database billing and coding articles: MCD release October 8, 2026 (effective October 4, 2026). Next CMS release: FY2028 code files, effective October 1, 2027 for the ICD-10-CM code descriptions; FY2028 final rule (August 2027), effective October 1, 2027; an April 1 interim grouper update when CMS issues one for the IPPS Table 5 (MS-DRG weights); PY2028 advance notice (February 2027) and the PY2027 midyear final mapping (spring 2027) for the ICD-10-CM to HCC mapping; weekly, every Thursday for the Medicare Coverage Database billing and coding articles.

Code
Z94.3
billable FY2027 ICD-10-CM code
Category
Z94 Transplanted organ and tissue status
Chapter
21: Factors influencing health status and contact with health services (Z00-Z99)
CC/MCC (MS-DRG v44)
CC
CMS-HCC V28
HCC 221, HCC 276
POA reporting
Exempt

Tabular list notes for Z94.3

The tabular list has no notes on Z94.3 itself; the notes below apply from its parent headings.

Inherited from Z94 (Transplanted organ and tissue status)

Includes
  • organ or tissue replaced by heterogenous or homogenous transplant
Excludes1 (never coded together)
  • complications of transplanted organ or tissue - see Alphabetical Index
Excludes2 (not part of this condition, may be coded together)
  • presence of vascular grafts (Z95.-)

MS-DRG grouping when Z94.3 is the principal diagnosis

MS-DRG v44 groups for Z94.3 as principal diagnosis
MDCMS-DRGs
05 MDC 05: Diseases and Disorders of the Circulatory System314315316

The final group also depends on procedures, secondary diagnoses and discharge status; the MS-DRG lookup for Z94.3 shows the full grouping logic.

CC/MCC status and inpatient edits

As a secondary diagnosis, Z94.3 is a CC under MS-DRG v44, unless the principal diagnosis is one of the 21 codes in its exclusion list. Check Z94.3 against a principal diagnosis.

  • Present on admission: exempt from POA indicator reporting (FY2027 exempt list).
  • Medicare Code Editor: unacceptable principal diagnosis.

CMS-HCC V28 risk adjustment

In the PY2027 mapping, Z94.3 maps to HCC 221 (Heart Transplant Status/Complications), HCC 276 (Lung Transplant Status/Complications). The HCC lookup shows the RAF weight and the hierarchy.

LCD billing and coding articles that list Z94.3

33 current Medicare billing and coding articles list Z94.3 among the diagnoses that support medical necessity for the services they cover.

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Frequently asked questions

What does ICD-10-CM Z94.3 mean?

Z94.3 means heart and lungs transplant status. It is one of 14 billable codes under Z94, transplanted organ and tissue status.

What can't be coded with Z94.3?

Excludes1 at Z94: complications of transplanted organ or tissue - see Alphabetical Index. These are never reported together with Z94.3.

Which MS-DRG does Z94.3 group to?

As the principal diagnosis, Z94.3 groups to MS-DRG 314 Other Circulatory System Diagnoses with MCC, MS-DRG 315 Other Circulatory System Diagnoses with CC, MS-DRG 316 Other Circulatory System Diagnoses without CC/MCC (MDC 05 MDC 05: Diseases and Disorders of the Circulatory System) under MS-DRG v44, before procedures and secondary diagnoses are applied.

Does Z94.3 map to an HCC?

Yes: HCC 221, Heart Transplant Status/Complications; HCC 276, Lung Transplant Status/Complications, in the PY2027 CMS-HCC V28 mapping.

Is Z94.3 a CC or MCC?

Z94.3 is a CC under MS-DRG v44; 21 principal diagnoses exclude it.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

Disclaimer

The descriptor and notes are reproduced from the FY2027 ICD-10-CM files; MS-DRG, CC/MCC and HCC facts come from the CMS FY2027 and PY2027 tables. Code from the medical record and the ICD-10-CM Official Guidelines. Not legal, clinical or billing advice.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.