M86.041
BillableAcute hematogenous osteomyelitis, right hand
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M86.041 an HCC code?
Yes. M86.041 maps to Bone/Joint/Muscle Infections/Necrosis under the CMS-HCC V28 risk adjustment model (and Bone/Joint/Muscle Infections/Necrosis under V24).
HCC Category Mapping
RAF weights shown are the community, non-dual, aged base weights from the CMS risk adjustment model file. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.
MEAT Criteria for M86.041
For M86.041 to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically — it has to be re-documented and supported each calendar year.
- MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
- EEvaluate: test results, medication response, or physical findings reviewed by the provider
- AAssess: explicit mention in the assessment or plan with acknowledgment of status
- TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis
Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed M86.041 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M86.041 is the ICD-10-CM diagnosis code for acute hematogenous osteomyelitis, right hand. A bone infection in the right hand caused by bacteria spreading through the bloodstream, typically affecting the small bones of the hand. M86.041 sits in the ICD-10-CM chapter for diseases of the musculoskeletal system and connective tissue (m00-m99), within the section covering other osteopathies (m86-m90).
Under the CMS-HCC V28 risk adjustment model, M86.041 maps to Bone/Joint/Muscle Infections/Necrosis (HCC 92) with a community, non-dual, aged base RAF weight of 0.209. Under the older V24 model, M86.041 mapped to the same category but with a base RAF weight of 0.482 — V28 recalibrated weights across the entire model. V28 is the CMS-HCC risk adjustment model that reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition.
Ensure documentation specifies 'right' hand to use this code; use M86.042 for left. Because M86.041 maps to a payment HCC, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's Medicare Advantage risk adjustment score. When documentation is ambiguous, coders should issue a provider query rather than assume the highest-specificity variant.
HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for M86.041 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation specifies 'right' hand to use this code; use M86.042 for left
- •This code includes all bones of the right hand; specify which bone if additional detail is needed
Clinical Significance
Acute hematogenous osteomyelitis of the right hand represents serious bloodstream-spread infection to the complex small bones of the hand, requiring immediate intensive treatment to prevent permanent functional disability. This location poses high risk for compartment syndrome, joint involvement, and loss of fine motor function essential for daily activities.
Documentation Requirements
- ✓Documentation of acute osteomyelitis affecting right hand bones
- ✓Evidence of hematogenous spread to hand structures
- ✓Clinical findings of right hand swelling, pain, dysfunction
- ✓Imaging studies showing hand bone infection
- ✓Blood cultures and hand tissue cultures when available
- ✓Treatment with IV antibiotics and possible surgical debridement
- ✓Assessment of neurovascular status and compartment pressures