Question 1

What is ICD-10 code M70.962?

Accepted Answer

M70.962 is the ICD-10-CM diagnosis code for unspecified soft tissue disorder related to use, overuse and pressure, left lower leg. A soft tissue problem in the left lower leg caused by repetitive use, overuse, or pressure, without a more specific diagnosis. M70.962 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering other soft tissue disorders (m70-m79).

M70.962 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.

Confirm left side is correctly documented in the medical record.

Question 2

Is M70.962 an HCC code?

Accepted Answer

No. M70.962 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 M70.962 billable?

Accepted Answer

Yes. M70.962 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. M70.962 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 M70.962?

Accepted Answer

M70.962 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 M70.962 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 M70.962?

Accepted Answer

Confirm left side is correctly documented in the medical record Consider if shin splints or other specific lower leg conditions can be more precisely coded

M70.962

Is M70.962 an HCC code?

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Open M70.962 in the Interactive Encoder