M86.062
BillableAcute hematogenous osteomyelitis, left tibia and fibula
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M86.062 an HCC code?
Yes. M86.062 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 M86.062
For M86.062 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 M86.062 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M86.062 is the ICD-10-CM diagnosis code for acute hematogenous osteomyelitis, left tibia and fibula. A bone infection in the left shin bones (tibia and fibula) caused by bacteria spreading through the bloodstream. M86.062 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, M86.062 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, M86.062 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 'left' to differentiate from M86.061. Because M86.062 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 M86.062 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation specifies 'left' to differentiate from M86.061
- •Both tibia and fibula are included in this code; document if only one bone is affected
Clinical Significance
Acute hematogenous osteomyelitis of the left tibia and fibula is a serious bloodstream-originated bone infection requiring aggressive treatment to prevent long-term complications including bone destruction, growth abnormalities, and chronic osteomyelitis. The involvement of both lower leg bones significantly impacts patient mobility and treatment complexity.
Documentation Requirements
- ✓Clear documentation of acute hematogenous osteomyelitis
- ✓Specific identification of left tibia and fibula involvement
- ✓Clinical symptoms supporting bone infection diagnosis
- ✓Radiological evidence of osteomyelitis in tibia and/or fibula
- ✓Laboratory findings consistent with bacterial infection
- ✓Blood culture results and antibiotic susceptibility when available
- ✓Documentation of pain severity and functional limitation
- ✓Treatment plan with IV antibiotic therapy duration