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M86.211 ICD-10-CM Code: Subacute osteomyelitis, right shoulder

M86.211 maps to CMS-HCC V28 92 (RAF 0.479). Documentation must support MEAT. MEAT criteria · RAF calculator · HCC Buddy coding tools

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

M86.211

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

Subacute osteomyelitis, right shoulder

A bone infection in the right shoulder that develops gradually over weeks to months, causing inflammation and potential bone damage.

Buddy the Bee presenting code insight

Buddy Insight

Subacute osteomyelitis of the right shoulder represents a bone infection with gradual onset over weeks to months, affecting the complex shoulder joint anatomy.

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
M86.2Subacute osteomyelitis
M86.21Subacute osteomyelitis, shoulder
M86.211Subacute osteomyelitis, right shoulder

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M86.211 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M86.211 in this effective period.

Related Child Codes

Official
M86.212Subacute osteomyelitis, left shoulder
M86.219Subacute osteomyelitis, unspecified shoulder

Includes

Official

ICD-10-CM does not list Includes notes for M86.211 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M86.211 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M86.211 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M86.211 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M86.211 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Specific identification of right shoulder involvement
Documentation of subacute timeline (weeks to months onset)
Clinical evidence of shoulder bone infection
Imaging confirmation of osteomyelitis in shoulder bones

MEAT Support

HCC Buddy guidance
Specific identification of right shoulder involvement
Documentation of subacute timeline (weeks to months onset)
Clinical evidence of shoulder bone infection
Imaging confirmation of osteomyelitis in shoulder bones

Audit Caution

HCC Buddy guidance
Confusing subacute timeline with acute or chronic phases
Missing the specific shoulder bone involvement
Not documenting functional impact adequately
Confusing with soft tissue shoulder conditions

Common Mistakes

HCC Buddy guidance
M86111 — Acute hematogenous osteomyelitis of right shoulder
M86611 — Chronic osteomyelitis with draining sinus of right shoulder
M86311 — Chronic multifocal osteomyelitis of right shoulder
M25511 — Pain in right shoulder (symptom only)

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 M86.211 an HCC code?

Yes. M86.211 (Subacute osteomyelitis, right shoulder) 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: M86.211 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
M86.211
Description
Subacute osteomyelitis, right shoulder
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 M86.211 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for M86.211

For M86.211 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 M86.211 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

M86.211 is the ICD-10-CM diagnosis code for subacute osteomyelitis, right shoulder. A bone infection in the right shoulder that develops gradually over weeks to months, causing inflammation and potential bone damage. M86.211 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, M86.211 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, M86.211 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 laterality is documented as right shoulder in the medical record before assigning this code. Because M86.211 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 M86.211 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 shoulder in the medical record before assigning this code
  • •Ensure the infection is confirmed as subacute (not acute or chronic) and document the causative organism if identified

Clinical Significance

Subacute osteomyelitis of the right shoulder represents a bone infection with gradual onset over weeks to months, affecting the complex shoulder joint anatomy. This intermediate timeline infection requires careful monitoring to prevent progression to chronic osteomyelitis and preserve shoulder function.

Documentation Requirements

  • ✓Specific identification of right shoulder involvement
  • ✓Documentation of subacute timeline (weeks to months onset)
  • ✓Clinical evidence of shoulder bone infection
  • ✓Imaging confirmation of osteomyelitis in shoulder bones
  • ✓Laboratory evidence of ongoing infection
  • ✓Assessment of shoulder range of motion and function
  • ✓Documentation of pain patterns and limitations
  • ✓Treatment plan for preserving shoulder mobility

Commonly Confused Codes

  • •M86111: Acute hematogenous osteomyelitis of right shoulder
  • •M86611: Chronic osteomyelitis with draining sinus of right shoulder
  • •M86311: Chronic multifocal osteomyelitis of right shoulder
  • •M25511: Pain in right shoulder (symptom only)
  • •M75.31: Calcific tendinitis of right shoulder

Child Codes

M86.211Subacute osteomyelitis, right shoulder
HCC 92
M86.212Subacute osteomyelitis, left shoulder
HCC 92
M86.219Subacute osteomyelitis, unspecified shoulder
HCC 92

Code Hierarchy

└M86Osteomyelitis└M86.2Subacute osteomyelitis└M86.21Subacute osteomyelitis, shoulder└M86.211Subacute osteomyelitis, right shoulder
└M86.211Subacute osteomyelitis, right shoulder

Because M86.211 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.

M86.211 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 M86.211 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.

Work M86.211 in HCC Buddy

Open M86.211 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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