What is ICD-10 code M86.119?

M86.119 is the ICD-10-CM diagnosis code for Other acute osteomyelitis, unspecified shoulder. A sudden bacterial bone infection in the shoulder that is not blood-borne in origin, when the specific side (left or right) is not documented. M86.119 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. M86.119 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. M86.119 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. M86.119 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

Which HCC does M86.119 map to under V28?

M86.119 maps to CMS-HCC V28 HCC 92 (Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis). The category numbers, labels, and conditions come from the CMS-HCC V28 model file for payment year 2026.

2026 ICD-10-CM M86.119: Other acute osteomyelitis

M86.119 maps to CMS-HCC V28 92. A source-labeled RAF reference is available. Confirm the documented diagnosis and applicable coding requirements. MEAT criteria · RAF Calculator · HCC coding software

ICD-10-CM Code View

HCC Buddy Code Card

Digital ICD-10 code-book layout with official code detail, always-visible risk models, Code Trumping, and Buddy coding guidance.

Code lookupM86.119

Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Other osteopathies (M86-M90)

M86.119

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Other acute osteomyelitis, unspecified shoulder

A sudden bacterial bone infection in the shoulder that is not blood-borne in origin, when the specific side (left or right) is not documented.

Buddy Insight

Other acute osteomyelitis of unspecified shoulder represents non-hematogenous bone infection where laterality cannot be determined from available documentation.

Overview Risk Models Code Book Documentation Audit Notes Edition comparison

CMS-HCC V28

Mapped

HCC 92

Bone/Joint/Muscle/Severe Soft...

Code-level coefficient reference

CMS-HCC V24

Historical

Not used for standard CY2026 Medicare Advantage payment. Select a historical period to review V24.

Not used for CY2026 payment

ACA/HHS

Mapped

HCC 055

HHS-HCC 055 adult, RAF varies...

Code-level coefficient reference

ESRD/PACE

Mapped

HCC 39

Bone/Joint/Muscle Infections/...

Code-level coefficient reference

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

M86.1Other acute osteomyelitis M86.11Other acute osteomyelitis, shoulder M86.119Other acute osteomyelitis, unspecified shoulder

Inclusion Terms

Official

No inclusion terms are included in this display for M86.119. Check the code and parent instructions in the Code Book.

Excludes 2

Official

arthropathic psoriasis (L40.5-)Inherited from M00-M99, M86
certain conditions originating in the perinatal period (P04-P96)Inherited from M00-M99, M86
certain infectious and parasitic diseases (A00-B99)Inherited from M00-M99, M86
compartment syndrome (traumatic) (T79.A-)Inherited from M00-M99, M86
complications of pregnancy, childbirth and the puerperium (O00-O9A)Inherited from M00-M99, M86
congenital malformations, deformations, and chromosomal abnormalities (Q00-Q99)Inherited from M00-M99, M86
endocrine, nutritional and metabolic diseases (E00-E88)Inherited from M00-M99, M86
injury, poisoning and certain other consequences of external causes (S00-T88)Inherited from M00-M99, M86
neoplasms (C00-D49)Inherited from M00-M99, M86
symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R94)Inherited from M00-M99, M86
ostemyelitis of:Inherited from M00-M99, M86
orbit (H05.0-)Inherited from M00-M99, M86
petrous bone (H70.2-)Inherited from M00-M99, M86
vertebra (M46.2-)Inherited from M00-M99, M86

Related Codes

Official

M86.111Other acute osteomyelitis, right shoulder M86.112Other acute osteomyelitis, left shoulder

Includes

Official

No Includes notes are included in this display for M86.119. Check the code and parent instructions in the Code Book.

Excludes 1

Official

postprocedural osteopathies (M96.-)Inherited from M86-M90, M86
osteomyelitis due to:Inherited from M86-M90, M86
echinococcus (B67.2)Inherited from M86-M90, M86
gonococcus (A54.43)Inherited from M86-M90, M86
salmonella (A02.24)Inherited from M86-M90, M86

Code First

Official

No Code First sequencing instructions are included in this display for M86.119. Check the code and parent instructions in the Code Book.

Use Additional

Official

code (B95-B97) to identify infectious agentInherited from M86
code to identify major osseous defect, if applicable (M89.7-)Inherited from M86

Code Also

Official

No Code Also instructions are included in this display for M86.119. Check the code and parent instructions in the Code Book.

Buddy Documentation Tip

HCC Buddy guidance

Documentation of acute osteomyelitis involving shoulder

Confirmation that infection is not hematogenous in origin

Evidence that shoulder laterality is unspecified or unknown

Clinical presentation consistent with shoulder bone infection

MEAT Support

HCC Buddy guidance

Documentation of acute osteomyelitis involving shoulder

Confirmation that infection is not hematogenous in origin

Evidence that shoulder laterality is unspecified or unknown

Clinical presentation consistent with shoulder bone infection

Audit Caution

HCC Buddy guidance

Using when laterality is documented elsewhere in the medical record

Failing to confirm non-hematogenous infection origin

Applying to shoulder conditions without confirmed bone involvement

Confusion between acute and other temporal disease classifications

Common Mistakes

HCC Buddy guidance

M86.111/M86.112 — Use when specific laterality (right/left) is documented

M86.019 — Use for acute hematogenous osteomyelitis of unspecified shoulder

M86.619 — Use for chronic osteomyelitis of unspecified shoulder

M75.3 — Use for calcific tendinitis without bone infection

Current with CMS: FY2026 ICD-10-CM Apr 1 update (effective Apr 1 – Sep 30, 2026) · CMS-HCC V28, 100% phased in for payment year 2026. FY2027 code set already staged for October 1, 2026. How HCC Buddy stays current →

Is M86.119 an HCC code?

Yes. M86.119 (Other acute osteomyelitis, unspecified shoulder) maps to HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.479. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: M86.119 is billable and maps to V28 HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis. Open it in the Code Book for the tabular path, RAF, and MEAT checklist.

Code: M86.119
Description: Other acute osteomyelitis, unspecified shoulder
HCC (V28): HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
RAF reference coefficient: 0.479
Billable: Yes
Payment year: 2026

HCC Category Mapping

V28HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis

0.479

ESRDHCC 39, Bone/Joint/Muscle Infections/Necrosis

Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. Weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work M86.119 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT review for M86.119

For M86.119, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule.

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

Coder workflow notes

Get the V28 mapping + MEAT cheat sheet

One printable reference: check representative V28 mappings and the documentation reminders your note needs. Free, no card.

Free PDF. No card. Unsubscribe anytime.

What This Code Means

M86.119 is the ICD-10-CM diagnosis code for other acute osteomyelitis, unspecified shoulder. A sudden bacterial bone infection in the shoulder that is not blood-borne in origin, when the specific side (left or right) is not documented. M86.119 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, M86.119 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis (HCC 92) with a source-labeled community, non-dual, aged reference coefficient of 0.479. No V24 mapping is shown for M86.119; use the applicable model and payment year when reviewing the V28 mapping. For CY2026 non-PACE Medicare Advantage, CMS uses 100% of the 2024 CMS-HCC model (V28). PACE uses a separate model blend. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Use this code only when laterality cannot be determined from documentation. For M86.119, confirm that the documentation supports the diagnosis and meets the applicable coding, encounter, program and payer requirements. MEAT (Monitor, Evaluate, Assess, or Treat) is a review mnemonic, not a universal CMS coding rule. 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, source-labeled coefficient references, and MEAT documentation criteria for M86.119 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code only when laterality cannot be determined from documentation
•Query provider if shoulder laterality is clinically relevant but not documented

Clinical Significance

Other acute osteomyelitis of unspecified shoulder represents non-hematogenous bone infection where laterality cannot be determined from available documentation. This condition requires immediate antibiotic intervention and close monitoring to prevent progression to chronic infection, joint destruction, and permanent shoulder dysfunction.