M86.061
BillableAcute hematogenous osteomyelitis, right tibia and fibula
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M86.061 an HCC code?
Yes. M86.061 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 M86.061
For M86.061 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 M86.061 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M86.061 is the ICD-10-CM diagnosis code for acute hematogenous osteomyelitis, right tibia and fibula. A bone infection in the right shin bones (tibia and fibula) caused by bacteria spreading through the bloodstream. M86.061 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, M86.061 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, M86.061 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.
This code includes both the tibia and fibula of the right leg; do not use if only one bone is affected. Because M86.061 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 M86.061 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code includes both the tibia and fibula of the right leg; do not use if only one bone is affected
- •Verify right side is documented; use M86.062 for left-sided infection
Clinical Significance
Acute hematogenous osteomyelitis of the right tibia and fibula represents a severe bloodstream-disseminated infection requiring immediate intervention to prevent complications such as growth disturbances, chronic infection, or sepsis. The dual bone involvement increases complexity and treatment duration compared to single-bone infections.
Documentation Requirements
- ✓Documentation of osteomyelitis as acute and hematogenous in origin
- ✓Specific identification of right tibia and fibula involvement
- ✓Clinical presentation consistent with bone infection (pain, fever, swelling, inability to bear weight)
- ✓Imaging studies confirming osteomyelitis in tibia and/or fibula bones
- ✓Laboratory markers supporting infection (elevated ESR, CRP, leukocytosis)
- ✓Blood culture results if available to identify causative organism
- ✓Documentation of treatment response and antibiotic sensitivity
- ✓Assessment of functional impact on ambulation or weight-bearing