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M86.152 ICD-10-CM Code: Other acute osteomyelitis, left femur

M86.152 maps to CMS-HCC V28 92 (RAF 0.479). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC coding software

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

M86.152

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

Other acute osteomyelitis, left femur

A sudden bone infection in the left thighbone (femur), usually caused by bacterial invasion through trauma, surgery, or systemic infection.

Buddy the Bee presenting code insight

Buddy Insight

Acute osteomyelitis of the left femur represents infection of the body's largest bone, posing significant risks for systemic complications and long-term mobility impairment.

CMS-HCC V28

HCC 92

RAF 0.479

CMS-HCC V24

HCC 39

RAF 0.401

ACA/HHS

HCC 55

Varies by metal level

ESRD/PACE

HCC 39

RAF 0.092

RXHCC

N/A

—

Not mapped

Code Book Path

Official
M86.1Other acute osteomyelitis
M86.15Other acute osteomyelitis, femur
M86.152Other acute osteomyelitis, left femur

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M86.152 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M86.152 in this effective period.

Related Child Codes

Official
M86.151Other acute osteomyelitis, right femur
M86.159Other acute osteomyelitis, unspecified femur

Includes

Official

ICD-10-CM does not list Includes notes for M86.152 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M86.152 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M86.152 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M86.152 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M86.152 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Specific identification of left femur involvement
Documentation of acute infection onset
Clinical evidence of femoral bone infection
Imaging confirmation of osteomyelitis in left femur

MEAT Support

HCC Buddy guidance
Specific identification of left femur involvement
Documentation of acute infection onset
Clinical evidence of femoral bone infection
Imaging confirmation of osteomyelitis in left femur

Audit Caution

HCC Buddy guidance
Confusing with hematogenous osteomyelitis when blood-borne origin documented
Missing the acute vs chronic distinction in documentation
Failing to capture associated hip or knee involvement separately
Coding based on imaging findings without clinical correlation

Common Mistakes

HCC Buddy guidance
M86112 — Acute hematogenous osteomyelitis of left femur
M86652 — Chronic osteomyelitis with draining sinus of left femur
M86252 — Subacute osteomyelitis of left femur
S72.002A — Fracture of unspecified part of neck of left femur

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 M86.152 an HCC code?

Yes. M86.152 (Other acute osteomyelitis, left femur) maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis under the CMS-HCC V28 risk adjustment model (and Bone/Joint/Muscle Infections/Necrosis under V24), with a community non-dual aged RAF of 0.479. It is billable for payment year 2026.

Coder answer: M86.152 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
M86.152
Description
Other acute osteomyelitis, left femur
HCC (V28)
HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
RAF
0.479
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
0.479
V24HCC 39, Bone/Joint/Muscle Infections/Necrosis
0.401
ESRDHCC 39, Bone/Joint/Muscle Infections/Necrosis
0.092

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work M86.152 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for M86.152

For M86.152 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 M86.152 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

M86.152 is the ICD-10-CM diagnosis code for other acute osteomyelitis, left femur. A sudden bone infection in the left thighbone (femur), usually caused by bacterial invasion through trauma, surgery, or systemic infection. M86.152 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, M86.152 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis (HCC 92) with a community, non-dual, aged base RAF weight of 0.479. Under the older CMS-HCC V24 model, M86.152 maps to Bone/Joint/Muscle Infections/Necrosis (HCC 39) with a community, non-dual, aged base RAF weight of 0.401. 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 'left' femur is clearly documented in the medical record. Because M86.152 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 M86.152 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Verify 'left' femur is clearly documented in the medical record
  • •Femur osteomyelitis is clinically significant; ensure acute status is confirmed and treatment plan is documented

Clinical Significance

Acute osteomyelitis of the left 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 left femur involvement
  • ✓Documentation of acute infection onset
  • ✓Clinical evidence of femoral bone infection
  • ✓Imaging confirmation of osteomyelitis in left femur
  • ✓Laboratory markers supporting active infection
  • ✓Assessment of weight-bearing status and mobility
  • ✓Documentation of pain and functional limitations
  • ✓Treatment plan including immobilization considerations

Commonly Confused Codes

  • •M86112: Acute hematogenous osteomyelitis of left femur
  • •M86652: Chronic osteomyelitis with draining sinus of left femur
  • •M86252: Subacute osteomyelitis of left femur
  • •S72.002A: Fracture of unspecified part of neck of left femur
  • •M25552: Pain in left hip

Child Codes

M86.151Other acute osteomyelitis, right femur
HCC 92
M86.152Other acute osteomyelitis, left femur
HCC 92
M86.159Other acute osteomyelitis, unspecified femur
HCC 92

Code Hierarchy

└M86Osteomyelitis└M86.1Other acute osteomyelitis└M86.15Other acute osteomyelitis, femur└M86.152Other acute osteomyelitis, left femur
└M86.152Other acute osteomyelitis, left femur

Because M86.152 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

M86.152 maps to CMS-HCC V28 category 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because M86.152 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

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