M86.619

Billable

Other chronic osteomyelitis, unspecified shoulder

HCC Category Mapping

V28HCC 92 — Bone/Joint/Muscle Infections/Necrosis

0.209

V24HCC 39 — Bone/Joint/Muscle Infections/Necrosis

0.482

ESRDHCC 39 — Bone/Joint/Muscle Infections/Necrosis

0.000

What This Code Means

A long-term bone infection in the shoulder area, but the specific side (left or right) is not documented.

Coding Tips

•Use only when shoulder laterality is not specified in the medical record
•Attempt to obtain laterality information from provider documentation

Clinical Significance

This code represents chronic osteomyelitis of the shoulder when laterality is not specified in documentation. While capturing the serious nature of chronic bone infection affecting shoulder function, the lack of laterality specification indicates potential documentation improvements needed for optimal treatment planning and care coordination.

Documentation Requirements

✓Documentation of chronic osteomyelitis (>6 weeks or recurrent)
✓Shoulder bone involvement without laterality specification
✓Non-hematogenous etiology (contiguous or direct inoculation)
✓Imaging confirmation of bone infection in shoulder region
✓Laboratory markers of infection or inflammation
✓Assessment of shoulder function and mobility
✓Treatment history and current management approach
✓Justification for unspecified laterality (bilateral or unclear documentation)

Commonly Confused Codes

M86.611 — Other chronic osteomyelitis, right shoulder (specific laterality)M86.612 — Other chronic osteomyelitis, left shoulder (specific laterality)M86.519 — Other chronic hematogenous osteomyelitis, unspecified shoulder (hematogenous)M86.419 — Chronic osteomyelitis with draining sinus, unspecified shoulder (has sinus)M86.119 — Other acute osteomyelitis, unspecified shoulder (acute phase)

Code Hierarchy

└M86Osteomyelitis └M86.6Other chronic osteomyelitis └M86.61Other chronic osteomyelitis, shoulder └M86.619Other chronic osteomyelitis, unspecified shoulder

└M86.619Other chronic osteomyelitis, unspecified shoulder