Question 1

What is ICD-10 code M85.362?

Accepted Answer

M85.362 is the ICD-10-CM diagnosis code for osteitis condensans, left lower leg. A condition where bone becomes abnormally dense and hardened in the left lower leg, typically occurring as a response to inflammation or stress on the bones. M85.362 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).

M85.362 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 specifies the left lower leg; confirm left-sided involvement is documented.

Question 2

Is M85.362 an HCC code?

Accepted Answer

No. M85.362 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 M85.362 billable?

Accepted Answer

Yes. M85.362 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. M85.362 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 M85.362?

Accepted Answer

M85.362 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 M85.362 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 M85.362?

Accepted Answer

This code specifies the left lower leg; confirm left-sided involvement is documented Review imaging reports to confirm osteitis condensans diagnosis in the tibia or fibula

M85.362

Is M85.362 an HCC code?

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Open M85.362 in the Interactive Encoder