M84.869
BillableOther disorders of continuity of bone, unspecified tibia and fibula
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M84.869 an HCC code?
No. M84.869 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
M84.869 is the ICD-10-CM diagnosis code for other disorders of continuity of bone, unspecified tibia and fibula. A bone disorder affecting the continuity or structural integrity of the shinbone or smaller leg bone when the specific side is not documented or is bilateral. M84.869 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering disorders of bone density and structure (m80-m85).
M84.869 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 only when laterality is unspecified or cannot be determined.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M84.869 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when laterality is unspecified or cannot be determined
- •Request clarification from provider regarding which leg is affected