M86.112
BillableOther acute osteomyelitis, left shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M86.112 an HCC code?
Yes. M86.112 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 M86.112
For M86.112 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 M86.112 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M86.112 is the ICD-10-CM diagnosis code for other acute osteomyelitis, left shoulder. A sudden bacterial bone infection in the left shoulder that is not blood-borne in origin, often resulting from trauma, surgery, or local spread of infection. M86.112 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, M86.112 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, M86.112 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 left; if not specified, use M86.119. Because M86.112 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 M86.112 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Other acute osteomyelitis of the left shoulder represents non-hematogenous bone infection that can severely compromise shoulder function and quality of life if not treated aggressively. This condition typically results from direct inoculation through trauma or surgery and requires prompt antibiotic therapy to prevent chronic infection and joint destruction.
Documentation Requirements
- ✓Clear documentation of acute osteomyelitis affecting left shoulder
- ✓Confirmation of non-hematogenous infection origin
- ✓Clinical signs of shoulder bone infection with pain and inflammation
- ✓Radiological evidence of osteomyelitis in left shoulder bones
- ✓Laboratory findings consistent with acute bacterial infection
- ✓Culture and sensitivity results when obtainable
- ✓Documentation of predisposing factors (trauma, surgery, immunocompromise)
- ✓Functional assessment including range of motion limitations