Question 1

What is ICD-10 code M75.112?

Accepted Answer

M75.112 is the ICD-10-CM diagnosis code for incomplete rotator cuff tear or rupture of left shoulder, not specified as traumatic. A partial tear or rupture of the rotator cuff muscles in the left shoulder that occurred without a specific traumatic injury. M75.112 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).

M75.112 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.

Use this code when documentation confirms a partial/incomplete tear of the left shoulder rotator cuff.

Question 2

Is M75.112 an HCC code?

Accepted Answer

No. M75.112 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 M75.112 billable?

Accepted Answer

Yes. M75.112 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. M75.112 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 M75.112?

Accepted Answer

M75.112 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 M75.112 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 5

What should coders know when reporting M75.112?

Accepted Answer

Use this code when documentation confirms a partial/incomplete tear of the left shoulder rotator cuff Review imaging or clinical notes to confirm the tear is incomplete rather than complete

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M75.112

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M75.112 ICD-10-CM Code: Incomplete rotator cuff tear or rupture of left shoulder, not specified as traumatic

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M75.112

Is M75.112 an HCC code?

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