M06.872
BillableOther specified rheumatoid arthritis, left ankle and foot
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M06.872 an HCC code?
Yes. M06.872 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease under the CMS-HCC V28 risk adjustment model (and Rheumatoid Arthritis and Inflammatory Connective Tissue Disease 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 M06.872
For M06.872to 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 M06.872 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M06.872 is the ICD-10-CM diagnosis code for other specified rheumatoid arthritis, left ankle and foot. A form of rheumatoid arthritis affecting the left ankle and foot, characterized by inflammation and joint damage that doesn't fit into other specific rheumatoid arthritis categories. M06.872 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering inflammatory polyarthropathies (m05-m14).
Under the CMS-HCC V28 risk adjustment model, M06.872 maps to Rheumatoid Arthritis and Inflammatory Connective Tissue Disease (HCC 93) with a community, non-dual, aged base RAF weight of 0.175. Under the older V24 model, M06.872 mapped to the same category but with a base RAF weight of 0.307 — V28 recalibrated weights across the entire model. 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.
Confirm left ankle and foot laterality is documented; this code covers both structures on the left side. Because M06.872 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 M06.872 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm left ankle and foot laterality is documented; this code covers both structures on the left side
- •Consider documenting specific joints involved (talocrural, subtalar, metatarsophalangeal) for clinical clarity
Clinical Significance
Other specified rheumatoid arthritis of left ankle and foot indicates a distinct form of RA affecting the lower extremity with potential for significant functional impairment. This condition requires specialized management and may impact mobility and weight-bearing activities.
Documentation Requirements
- ✓Confirmed diagnosis of rheumatoid arthritis
- ✓Specific documentation of left ankle and foot involvement
- ✓Clear laterality specification (left side)
- ✓Description of the specific type of RA manifestation
- ✓Functional assessment of ankle and foot mobility
- ✓Laboratory confirmation of RA diagnosis
- ✓Documentation of disease activity and severity
- ✓Treatment plan and response to therapy