M86.421
BillableChronic osteomyelitis with draining sinus, right humerus
HCC Category Mapping
V28HCC 92 — Bone/Joint/Muscle Infections/Necrosis
0.209V24HCC 39 — Bone/Joint/Muscle Infections/Necrosis
0.482ESRDHCC 39 — Bone/Joint/Muscle Infections/Necrosis
0.000What This Code Means
A long-term bone infection in the right upper arm bone (humerus) with an open drainage tract that allows infected material to drain through the skin.
Coding Tips
- •Confirm laterality is documented as right; if left is documented, use M86.422 instead
- •Ensure documentation supports both chronic osteomyelitis diagnosis and the presence of a draining sinus
Clinical Significance
Chronic osteomyelitis with draining sinus of the right humerus represents a severe bone infection of the upper arm with persistent drainage, significantly impacting arm function and quality of life. The draining sinus indicates treatment-resistant disease requiring comprehensive management and monitoring for complications.
Documentation Requirements
- ✓Specific documentation of right humerus involvement
- ✓Evidence of chronicity (>6 weeks duration or recurrent episodes)
- ✓Confirmation of active draining sinus tract from humerus
- ✓Imaging findings demonstrating chronic osteomyelitic changes
- ✓Clinical assessment of right arm function and drainage
- ✓Laboratory markers supporting chronic infectious process
- ✓Treatment history addressing infection and sinus management
- ✓Provider assessment confirming chronic osteomyelitis with drainage
Commonly Confused Codes
M86.521 — Other chronic hematogenous osteomyelitis, right humerus, no drainageM86.422 — Same condition affecting left humerusM86.321 — Chronic multifocal osteomyelitis, right humerus, no drainageM86.121 — Acute osteomyelitis of right humerus, acute vs chronicL02.421 — Cutaneous abscess of right upper limb, superficial vs bone
Code Hierarchy
└M86Osteomyelitis└M86.4Chronic osteomyelitis with draining sinus└M86.42Chronic osteomyelitis with draining sinus, humerus└M86.421Chronic osteomyelitis with draining sinus, right humerus
└M86.421Chronic osteomyelitis with draining sinus, right humerus