M86.419

HCC Category Mapping

What This Code Means

A long-term bone infection in the shoulder that has created an open drainage tract allowing pus or fluid to drain to the skin surface, with the specific shoulder not identified.

Coding Tips

• •This code requires documentation of chronicity and the presence of a draining sinus tract; verify the shoulder side is truly unspecified before using this code
• •If the specific shoulder (right or left) is documented, use M86.411 or M86.412 instead for greater specificity

Clinical Significance

Chronic osteomyelitis with draining sinus of unspecified shoulder indicates a severe bone infection with persistent drainage when laterality is not documented, representing complex disease requiring intensive management. The draining component significantly complicates treatment and increases risk for treatment failure.

Documentation Requirements

• ✓Documentation of shoulder involvement without laterality specification
• ✓Evidence of chronic infection (>6 weeks duration or recurrent)
• ✓Confirmation of active draining sinus tract
• ✓Radiographic findings consistent with chronic osteomyelitis
• ✓Clinical evidence of persistent drainage from shoulder
• ✓Laboratory evidence supporting chronic infectious process
• ✓Treatment history addressing both infection and drainage
• ✓Absence of clear laterality information in medical record

Commonly Confused Codes