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M86.612 ICD-10-CM Code: Other chronic osteomyelitis, left shoulder

M86.612 maps to CMS-HCC V28 92 (RAF 0.479). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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

M86.612

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

Other chronic osteomyelitis, left shoulder

A long-term bone infection in the left shoulder area.

Buddy the Bee presenting code insight

Buddy Insight

Chronic osteomyelitis of the left shoulder represents a persistent bone infection that severely compromises upper extremity function and quality of life.

CMS-HCC V28

HCC 92

RAF 0.479

CMS-HCC V24

HCC 39

RAF 0.401

ACA/HHS

HCC 55

Varies by metal level

ESRD/PACE

HCC 39

RAF 0.092

RXHCC

N/A

—

Not mapped

Code Book Path

Official
M86.6Other chronic osteomyelitis
M86.61Other chronic osteomyelitis, shoulder
M86.612Other chronic osteomyelitis, left shoulder

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M86.612 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M86.612 in this effective period.

Related Child Codes

Official
M86.611Other chronic osteomyelitis, right shoulder
M86.619Other chronic osteomyelitis, unspecified shoulder

Includes

Official

ICD-10-CM does not list Includes notes for M86.612 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M86.612 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M86.612 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M86.612 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M86.612 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Confirmation of chronic nature (minimum 6 weeks duration or recurrent)
Specific documentation of left shoulder bone involvement
Non-hematogenous etiology (contiguous spread or direct inoculation)
Radiographic evidence of bone infection or osteomyelitic changes

MEAT Support

HCC Buddy guidance
Confirmation of chronic nature (minimum 6 weeks duration or recurrent)
Specific documentation of left shoulder bone involvement
Non-hematogenous etiology (contiguous spread or direct inoculation)
Radiographic evidence of bone infection or osteomyelitic changes

Audit Caution

HCC Buddy guidance
Distinguishing from hematogenous osteomyelitis which requires different coding
Missing non-hematogenous etiology when coding this specific category
Incorrectly coding acute exacerbations as new acute osteomyelitis
Using draining sinus codes without proper documentation

Common Mistakes

HCC Buddy guidance
M86.512 — Other chronic hematogenous osteomyelitis, left shoulder (hematogenous origin)
M86.611 — Other chronic osteomyelitis, right shoulder (opposite side)
M86.412 — Chronic osteomyelitis with draining sinus, left shoulder (has sinus tract)
M86.112 — Other acute osteomyelitis, left shoulder (acute presentation)

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 M86.612 an HCC code?

Yes. M86.612 (Other chronic osteomyelitis, left 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: M86.612 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
M86.612
Description
Other chronic osteomyelitis, left 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 M86.612 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for M86.612

For M86.612 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 M86.612 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

M86.612 is the ICD-10-CM diagnosis code for other chronic osteomyelitis, left shoulder. A long-term bone infection in the left shoulder area. M86.612 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, M86.612 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, M86.612 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.

Ensure left shoulder is clearly documented to differentiate from right-sided infection. Because M86.612 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 M86.612 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Ensure left shoulder is clearly documented to differentiate from right-sided infection
  • •Verify this is chronic osteomyelitis rather than acute infection

Clinical Significance

Chronic osteomyelitis of the left shoulder represents a persistent bone infection that severely compromises upper extremity function and quality of life. This condition often requires prolonged antibiotic therapy and may necessitate surgical intervention, significantly impacting the patient's ability to perform work and daily activities.

Documentation Requirements

  • ✓Confirmation of chronic nature (minimum 6 weeks duration or recurrent)
  • ✓Specific documentation of left shoulder bone involvement
  • ✓Non-hematogenous etiology (contiguous spread or direct inoculation)
  • ✓Radiographic evidence of bone infection or osteomyelitic changes
  • ✓Laboratory studies supporting chronic infection process
  • ✓Functional assessment of left shoulder and upper extremity
  • ✓Documentation of antibiotic therapy and surgical procedures
  • ✓Assessment of occupational and functional limitations

Commonly Confused Codes

  • •M86.512: Other chronic hematogenous osteomyelitis, left shoulder (hematogenous origin)
  • •M86.611: Other chronic osteomyelitis, right shoulder (opposite side)
  • •M86.412: Chronic osteomyelitis with draining sinus, left shoulder (has sinus tract)
  • •M86.112: Other acute osteomyelitis, left shoulder (acute presentation)
  • •M75.32: Calcific tendinitis of left shoulder (soft tissue condition)

Child Codes

M86.611Other chronic osteomyelitis, right shoulder
HCC 92
M86.612Other chronic osteomyelitis, left shoulder
HCC 92
M86.619Other chronic osteomyelitis, unspecified shoulder
HCC 92

Code Hierarchy

└M86Osteomyelitis└M86.6Other chronic osteomyelitis└M86.61Other chronic osteomyelitis, shoulder└M86.612Other chronic osteomyelitis, left shoulder
└M86.612Other chronic osteomyelitis, left shoulder

Because M86.612 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.

M86.612 maps to CMS-HCC V28 category 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis. See the ICD-10 to HCC mapping hub for how the V28 crosswalk works. Because M86.612 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

Work M86.612 in HCC Buddy

Open M86.612 in the Code Book for the full Index-to-Tabular path, MEAT checklist, and V28 HCC mapping, or in the Encoder to code from a keyword search. Pro includes 7 days to try everything, no card required.

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