M86.071
BillableAcute hematogenous osteomyelitis, right ankle and foot
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M86.071 an HCC code?
Yes. M86.071 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 M86.071
For M86.071 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 M86.071 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M86.071 is the ICD-10-CM diagnosis code for acute hematogenous osteomyelitis, right ankle and foot. A bacterial bone infection in the right ankle or foot that develops suddenly, typically spreading through the bloodstream from another infection site in the body. M86.071 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, M86.071 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, M86.071 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.
Verify laterality is documented as right; if not specified, use M86.079 instead. Because M86.071 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 M86.071 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify laterality is documented as right; if not specified, use M86.079 instead
- •Confirm the infection is acute hematogenous type (blood-borne) rather than other osteomyelitis types
Clinical Significance
Acute hematogenous osteomyelitis of the right ankle and foot represents a serious bloodstream-originated infection that can rapidly progress to joint destruction, chronic infection, or systemic complications. The complex anatomy of the foot requires aggressive treatment to preserve function and prevent long-term disability.
Documentation Requirements
- ✓Clear documentation of acute hematogenous osteomyelitis
- ✓Specific identification of right ankle and/or foot bone involvement
- ✓Clinical presentation with pain, swelling, erythema, and possible fever
- ✓Imaging studies confirming bone infection in ankle/foot structures
- ✓Laboratory evidence of active bacterial infection
- ✓Blood cultures and organism identification when possible
- ✓Assessment of weight-bearing ability and gait disturbance
- ✓Documentation of antibiotic therapy regimen and response