What is ICD-10 code M86.519?

M86.519 is the ICD-10-CM diagnosis code for Other chronic hematogenous osteomyelitis, unspecified shoulder. A chronic bone infection of the shoulder from a bloodstream source when the specific side (left or right) is not documented. M86.519 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. M86.519 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. M86.519 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. M86.519 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for M86.519?

CMS phased in the V28 risk adjustment model over payment years 2024 (33%), 2025 (67%), and 2026 (100%), replacing V24. V28 consolidates HCC categories, removes some lower-acuity conditions, and recalibrates RAF weights across the entire model. For M86.519, V28 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis at RAF 0.479 while V24 mapped to Bone/Joint/Muscle Infections/Necrosis at RAF 0.401. Both models can still appear in legacy data and in payer-specific lookback periods.

What should coders know when reporting M86.519?

Use this code only when laterality cannot be determined from the medical record Query the provider if documentation is ambiguous about which shoulder is affected to allow for more specific coding Because M86.519 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.

2026 ICD-10-CM M86.519: Other chronic hematogenous

ICD-10-CM Code View

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Code lookupM86.519Effective periodFY2026 Apr Update (Apr 1-Sep 30)

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

M86.519

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

Other chronic hematogenous osteomyelitis, unspecified shoulder

A chronic bone infection of the shoulder from a bloodstream source when the specific side (left or right) is not documented.

Buddy Insight

Other chronic hematogenous osteomyelitis of unspecified shoulder indicates a blood-borne bone infection that has become chronic with shoulder involvement but without laterality specification.

CMS-HCC V28

Mapped

HCC 92

Bone/Joint/Muscle/Severe Soft...

RAF 0.479

CMS-HCC V24

Mapped

HCC 39

Bone/Joint/Muscle Infections/...

RAF 0.401

ACA/HHS

Mapped

HCC 55

HHS-HCC 55

Varies by metal level

ESRD/PACE

Mapped

HCC 39

Bone/Joint/Muscle Infections/...

RAF 0.092

RXHCC

N/A

—

Not risk-adjusted for this model/period.

Not mapped

Code Book Path

Official

M86.5Other chronic hematogenous osteomyelitis

M86.51Other chronic hematogenous osteomyelitis, shoulder

M86.519Other chronic hematogenous osteomyelitis, unspecified shoulder

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M86.519 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M86.519 in this effective period.

Related Child Codes

Official

M86.511Other chronic hematogenous osteomyelitis, right shoulder

M86.512Other chronic hematogenous osteomyelitis, left shoulder

Includes

Official

ICD-10-CM does not list Includes notes for M86.519 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M86.519 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M86.519 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M86.519 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M86.519 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Clear documentation of chronic osteomyelitis diagnosis

Evidence of hematogenous (blood-borne) etiology

Shoulder involvement specified without laterality designation

Laboratory evidence of systemic infection process

MEAT Support

HCC Buddy guidance

Clear documentation of chronic osteomyelitis diagnosis

Evidence of hematogenous (blood-borne) etiology

Shoulder involvement specified without laterality designation

Laboratory evidence of systemic infection process

Audit Caution

HCC Buddy guidance

Using this code when laterality is actually documented in the record

Missing the hematogenous specification when blood origin is documented

Confusing with other types of chronic shoulder osteomyelitis

Failing to distinguish hematogenous from direct spread etiology

Common Mistakes

HCC Buddy guidance

M86.511 — Other chronic hematogenous osteomyelitis, right shoulder (has laterality)

M86.512 — Other chronic hematogenous osteomyelitis, left shoulder (has laterality)

M86.619 — Other chronic osteomyelitis, unspecified shoulder (not specifically hematogenous)

M86.319 — Chronic multifocal osteomyelitis, unspecified shoulder (multifocal pattern)

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 M86.519 an HCC code?

Yes. M86.519 (Other chronic hematogenous osteomyelitis, unspecified 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: M86.519 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: M86.519
Description: Other chronic hematogenous osteomyelitis, unspecified 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 M86.519 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for M86.519

For M86.519 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 M86.519 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

M86.519 is the ICD-10-CM diagnosis code for other chronic hematogenous osteomyelitis, unspecified shoulder. A chronic bone infection of the shoulder from a bloodstream source when the specific side (left or right) is not documented. M86.519 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, M86.519 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, M86.519 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.

Use this code only when laterality cannot be determined from the medical record. Because M86.519 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 M86.519 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Use this code only when laterality cannot be determined from the medical record
•Query the provider if documentation is ambiguous about which shoulder is affected to allow for more specific coding

Clinical Significance

Other chronic hematogenous osteomyelitis of unspecified shoulder indicates a blood-borne bone infection that has become chronic with shoulder involvement but without laterality specification. This condition represents systemic infection with localized bone manifestation requiring prolonged treatment, though the unspecified nature may limit precise treatment planning and functional assessment.

Documentation Requirements

✓Clear documentation of chronic osteomyelitis diagnosis
✓Evidence of hematogenous (blood-borne) etiology
✓Shoulder involvement specified without laterality designation
✓Laboratory evidence of systemic infection process
✓Blood cultures or markers indicating hematogenous spread
✓Treatment history and current antibiotic regimens
✓Imaging studies confirming shoulder bone infection
✓Assessment of treatment response and functional status

Commonly Confused Codes

•M86.511: Other chronic hematogenous osteomyelitis, right shoulder (has laterality)
•M86.512: Other chronic hematogenous osteomyelitis, left shoulder (has laterality)
•M86.619: Other chronic osteomyelitis, unspecified shoulder (not specifically hematogenous)
•M86.319: Chronic multifocal osteomyelitis, unspecified shoulder (multifocal pattern)