M00.872
BillableArthritis due to other bacteria, left ankle and foot
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M00.872 an HCC code?
Yes. M00.872 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis under the CMS-HCC V28 risk adjustment model (and Bone/Joint/Muscle Infections/Necrosis under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for M00.872
For M00.872to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed M00.872 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M00.872 is the ICD-10-CM diagnosis code for arthritis due to other bacteria, left ankle and foot. Bacterial infection causing inflammation and swelling in the left ankle and foot joints, caused by bacteria other than the most common types. M00.872 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering infectious arthropathies (m00-m02).
Under the CMS-HCC V28 risk adjustment model, M00.872 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis (HCC 92) with a community, non-dual, aged base RAF weight of 0.479. Under the older CMS-HCC V24 model, M00.872 maps to Bone/Joint/Muscle Infections/Necrosis (HCC 39) with a community, non-dual, aged base RAF weight of 0.401. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Ensure bacterial organism identification is documented; if absent, use M00.879. Because M00.872 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M00.872 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure bacterial organism identification is documented; if absent, use M00.879
- •Verify left ankle and foot laterality is clearly stated to differentiate from right side
Clinical Significance
Bacterial arthritis of the left ankle and foot represents a serious threat to mobility involving multiple small joints crucial for weight-bearing and balance. This condition requires immediate treatment to prevent joint destruction and preserve ambulatory function.
Documentation Requirements
- ✓Documentation of 'other bacteria' as infectious agent
- ✓Clear identification of left ankle and foot involvement
- ✓Laboratory confirmation of bacterial infection
- ✓Clinical findings consistent with infectious arthritis
- ✓Evidence of appropriate antibiotic therapy
- ✓Assessment of ambulatory function and weight-bearing
- ✓Inflammatory markers and culture results
- ✓Differentiation from soft tissue infections
Commonly Confused Codes
- •M00072 — Streptococcal arthritis of left ankle/foot (different bacterial type)
- •M00017 — Staphylococcal arthritis of left ankle/foot (specific organism)
- •M06.872 — Other rheumatoid arthritis of left ankle/foot (autoimmune)
- •L03.115 — Cellulitis of left foot (soft tissue)
- •M19.072 — Primary osteoarthritis of left ankle/foot (degenerative)