M85.461 ICD-10-CM Code: Solitary bone cyst, right tibia and fibula
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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Disorders of bone density and structure (M80-M85)
M85.461
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceSolitary bone cyst, right tibia and fibula
A noncancerous fluid-filled cavity that forms in the right shinbone or smaller bone of the lower leg.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
00
RAF 0
ACA/HHS
00
RAF 0
ESRD/PACE
00
RAF 0
RXHCC
00
RAF 0
Code Trumping
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Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for M85.461 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M85.461 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M85.461 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M85.461 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M85.461 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M85.461 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M85.461 in this effective period.
Buddy Documentation Tip
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is M85.461 an HCC code?
No. M85.461 is a billable ICD-10-CM code but does not map to any HCC category in V28, V24, ESRD, or RxHCC.
Coder workflow notes
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This code does not map to an HCC category in any model (V28, V24, ESRD, RxHCC).
What This Code Means
M85.461 is the ICD-10-CM diagnosis code for solitary bone cyst, right tibia and fibula. A noncancerous fluid-filled cavity that forms in the right shinbone or smaller bone of the lower leg. M85.461 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).
M85.461 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 laterality is documented as right in the medical record.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M85.461 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm laterality is documented as right in the medical record
- •Distinguish between solitary cyst and aneurysmal cyst, which have different codes