Question 1

What is ICD-10 code M67.912?

Accepted Answer

M67.912 is the ICD-10-CM diagnosis code for unspecified disorder of synovium and tendon, left shoulder. An unspecified problem with the joint lining or tendons in the left shoulder area. M67.912 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering disorders of synovium and tendon (m65-m67).

M67.912 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.

Verify left shoulder laterality is explicitly documented in the clinical record.

Question 2

Is M67.912 an HCC code?

Accepted Answer

No. M67.912 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 M67.912 billable?

Accepted Answer

Yes. M67.912 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. M67.912 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

Which HCC does M67.912 map to under V28?

Accepted Answer

M67.912 does not map to a CMS-HCC V28 payment category. Check the current CMS-HCC V28 model file for payment year 2026 rather than an older V24 tip sheet.

Question 5

What does M67.912 pay in RAF?

Accepted Answer

M67.912 has no separately stated V28 community RAF weight. If it is not a V28 payment HCC, it adds nothing to a community RAF score.

Question 6

What is the V28 vs V24 difference for M67.912?

Accepted Answer

M67.912 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 community model rewards M67.912 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

Question 7

What documentation supports M67.912?

Accepted Answer

Verify left shoulder laterality is explicitly documented in the clinical record. This unspecified code should be used only when the specific disorder cannot be determined from available documentation. M67.912 is not a CMS-HCC payment code, so MEAT is not the payment hook. Documentation still has to support the diagnosis if you report it.

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M67.912

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M67.912 ICD-10-CM Code: Unspecified disorder of synovium and tendon, left shoulder

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M67.912

Is M67.912 an HCC code?

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