M86.431
BillableChronic osteomyelitis with draining sinus, right radius and ulna
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M86.431 an HCC code?
Yes. M86.431 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 M86.431
For M86.431 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 M86.431 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M86.431 is the ICD-10-CM diagnosis code for chronic osteomyelitis with draining sinus, right radius and ulna. A long-term bone infection in the right forearm bones (radius and ulna) with an open drainage tract allowing infected material to drain through the skin. M86.431 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, M86.431 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, M86.431 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.
This code applies to both radius and ulna on the right side; if only one bone is affected, documentation should still support this code as written. Because M86.431 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 M86.431 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code applies to both radius and ulna on the right side; if only one bone is affected, documentation should still support this code as written
- •Verify right side is documented; use M86.432 for left side involvement
Clinical Significance
Chronic osteomyelitis with draining sinus of the right radius and ulna represents a severe bone infection affecting both forearm bones with persistent drainage, significantly impacting hand and wrist function. The draining component indicates treatment-resistant disease requiring comprehensive management.
Documentation Requirements
- ✓Specific documentation of right radius and ulna involvement
- ✓Evidence of chronicity (>6 weeks duration or recurrent episodes)
- ✓Confirmation of active draining sinus tract from forearm bones
- ✓Imaging findings demonstrating chronic osteomyelitic changes
- ✓Assessment of right forearm function and drainage characteristics
- ✓Laboratory markers supporting chronic infectious process
- ✓Treatment history addressing infection and sinus management
- ✓Provider assessment confirming chronic osteomyelitis with drainage