Question 1

What is ICD-10 code M60.172?

Accepted Answer

M60.172 is the ICD-10-CM diagnosis code for interstitial myositis, left ankle and foot. Inflammation of the muscle tissue in the left ankle and foot, characterized by swelling and irritation within the muscle layers. M60.172 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering disorders of muscles (m60-m63).

M60.172 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

This code is specific to the left ankle and foot; use M60.171 for right side and M60.179 for unspecified side.

Question 2

Is M60.172 an HCC code?

Accepted Answer

No. M60.172 is a billable ICD-10-CM code but does not map to any payment HCC category under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can still be reported on Medicare Advantage encounter data submissions, but it does not contribute to the beneficiary's Risk Adjustment Factor (RAF) score and therefore does not affect the risk-adjusted capitation payment to the plan. V28 reached 100% phase-in for payment year 2026.

Question 3

Is M60.172 billable?

Accepted Answer

Yes. M60.172 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. M60.172 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Question 4

What is the V28 vs V24 difference for M60.172?

Accepted Answer

M60.172 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither model rewards M60.172 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a payment HCC.

Question 5

What should coders know when reporting M60.172?

Accepted Answer

This code is specific to the left ankle and foot; use M60.171 for right side and M60.179 for unspecified side Interstitial myositis involves inflammation between muscle fibers; document the specific anatomical location clearly in the medical record

M60.172

Is M60.172 an HCC code?

What This Code Means

Coding Tips

Code Hierarchy

Open M60.172 in the Interactive Encoder