M86.151
BillableOther acute osteomyelitis, right femur
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M86.151 an HCC code?
Yes. M86.151 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 M86.151
For M86.151 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 M86.151 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M86.151 is the ICD-10-CM diagnosis code for other acute osteomyelitis, right femur. A sudden bone infection in the right thighbone (femur), the largest bone in the body, typically caused by bacteria entering through injury or the bloodstream. M86.151 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, M86.151 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, M86.151 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.
Confirm 'right' femur is documented; femur infections can be serious given the bone's size and weight-bearing function. Because M86.151 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 M86.151 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm 'right' femur is documented; femur infections can be serious given the bone's size and weight-bearing function
- •Document the source of infection (trauma, hematogenous spread) if available for clinical context
Clinical Significance
Acute osteomyelitis of the right femur represents infection of the body's largest bone, posing significant risks for systemic complications and long-term mobility impairment. This condition requires aggressive treatment due to the femur's critical role in weight-bearing and ambulation.
Documentation Requirements
- ✓Specific identification of right femur involvement
- ✓Documentation of acute infection onset
- ✓Clinical evidence of femoral bone infection
- ✓Imaging confirmation of osteomyelitis in right femur
- ✓Laboratory markers supporting active infection
- ✓Assessment of weight-bearing status and mobility
- ✓Documentation of pain and functional limitations
- ✓Treatment plan including immobilization considerations