M86.272
BillableSubacute osteomyelitis, left ankle and foot
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M86.272 an HCC code?
Yes. M86.272 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 M86.272
For M86.272 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 M86.272 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M86.272 is the ICD-10-CM diagnosis code for subacute osteomyelitis, left ankle and foot. A bone infection in the left ankle and foot bones that develops gradually over weeks to months. M86.272 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, M86.272 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, M86.272 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 left-sided location is clearly stated in the clinical documentation. Because M86.272 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 M86.272 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify left-sided location is clearly stated in the clinical documentation
- •Document any diabetic foot complications or peripheral vascular disease that may be contributing factors
Clinical Significance
Subacute osteomyelitis of the left ankle and foot is an intermediate-phase bone infection that develops gradually over weeks to months, creating significant functional impairment and risk of progression to chronic infection. The intricate bone structure of the foot requires aggressive treatment to preserve mobility and prevent long-term complications.
Documentation Requirements
- ✓Documentation of subacute osteomyelitis affecting left ankle and/or foot
- ✓Clinical evidence of infection developing over weeks to months
- ✓Specific left-sided involvement documented
- ✓Radiological confirmation of bone infection in ankle/foot bones
- ✓Laboratory markers supporting ongoing infectious process
- ✓Culture and organism identification when possible
- ✓Functional assessment including mobility restrictions
- ✓Treatment response and follow-up documentation