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M86.649 ICD-10-CM Code: Other chronic osteomyelitis, unspecified hand

M86.649 maps to CMS-HCC V28 92. A source-labeled RAF reference is available. Documentation must support MEAT. MEAT criteria · RAF Calculator · HCC Buddy coding tools

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

M86.649

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

Other chronic osteomyelitis, unspecified hand

A chronic bone infection in the hand where the specific side (left or right) is not specified or documented.

Buddy the Bee presenting code insight

Buddy Insight

Other chronic osteomyelitis of unspecified hand represents a persistent bone infection affecting the hand structures without laterality specification.

CMS-HCC V28

HCC 92

Code-level coefficient reference

CMS-HCC V24

Historical

Historical

Not used for CY2026 payment

ACA/HHS

HCC 055

Code-level coefficient reference

ESRD/PACE

HCC 39

Code-level coefficient reference

RXHCC

N/A

—

Not mapped

Code Book Path

Official
M86.6Other chronic osteomyelitis
M86.64Other chronic osteomyelitis, hand
M86.649Other chronic osteomyelitis, unspecified hand

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M86.649 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M86.649 in this effective period.

Related Child Codes

Official
M86.641Other chronic osteomyelitis, right hand
M86.642Other chronic osteomyelitis, left hand

Includes

Official

ICD-10-CM does not list Includes notes for M86.649 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M86.649 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M86.649 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M86.649 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M86.649 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Clear documentation of chronic osteomyelitis diagnosis
Evidence of hand bone involvement without laterality specified
Confirmation of chronic duration and persistence
Laboratory studies supporting ongoing infection

MEAT Support

HCC Buddy guidance
Clear documentation of chronic osteomyelitis diagnosis
Evidence of hand bone involvement without laterality specified
Confirmation of chronic duration and persistence
Laboratory studies supporting ongoing infection

Audit Caution

HCC Buddy guidance
Using this code when laterality is actually documented in the record
Missing specific hand bone involvement when documented (metacarpals, phalanges)
Confusing with wrist involvement which has different coding
Failing to distinguish from acute osteomyelitis presentations

Common Mistakes

HCC Buddy guidance
M86.641 — Other chronic osteomyelitis, right hand (has laterality specified)
M86.642 — Other chronic osteomyelitis, left hand (has laterality specified)
M86.549 — Other chronic hematogenous osteomyelitis, unspecified hand (specifically hematogenous)
M86.449 — Chronic osteomyelitis with draining sinus, unspecified hand (has draining sinus)

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 M86.649 an HCC code?

Yes. M86.649 (Other chronic osteomyelitis, unspecified hand) maps to HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis under the CMS-HCC V28 risk adjustment model, with a source-labeled community non-dual aged reference coefficient of 0.479. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes. It is billable for payment year 2026.

Coder answer: M86.649 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
M86.649
Description
Other chronic osteomyelitis, unspecified hand
HCC (V28)
HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
RAF reference coefficient
0.479
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
0.479
ESRDHCC 39, Bone/Joint/Muscle Infections/Necrosis
Not separately weighted

These are source-labeled model coefficients, not member totals. A category may still be removed by hierarchy or model cleanup rules. 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 context, hierarchy and cleanup rules, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains available for historical review.

Work M86.649 in the Code Book — tabular path, V28 RAF reference, and MEAT checklist →

MEAT Criteria for M86.649

For M86.649 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 M86.649 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

M86.649 is the ICD-10-CM diagnosis code for other chronic osteomyelitis, unspecified hand. A chronic bone infection in the hand where the specific side (left or right) is not specified or documented. M86.649 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, M86.649 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis (HCC 92) with a source-labeled community, non-dual, aged reference coefficient of 0.479. No V24 mapping is shown for M86.649; use the applicable model and payment year when reviewing the V28 mapping. 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. Source-labeled code-level coefficients are references, not member totals. Actual contribution depends on complete member context, hierarchy and cleanup rules, interactions, and model year. HCC Buddy's RAF Calculator supports CMS-HCC V28 PY2026 and shows no score unless every required source and calculation check passes.

Use this code only when laterality is truly unspecified in the medical record. Because M86.649 maps to an HCC category, the provider's documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment. 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, source-labeled coefficient references, and MEAT documentation criteria for M86.649 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 is truly unspecified in the medical record
  • •Query provider to determine which hand is affected for more accurate coding

Clinical Significance

Other chronic osteomyelitis of unspecified hand represents a persistent bone infection affecting the hand structures without laterality specification. This condition significantly impacts fine motor function, grip strength, and activities of daily living, requiring prolonged treatment and rehabilitation while the unspecified nature may limit targeted therapeutic approaches and functional outcome planning.

Documentation Requirements

  • ✓Clear documentation of chronic osteomyelitis diagnosis
  • ✓Evidence of hand bone involvement without laterality specified
  • ✓Confirmation of chronic duration and persistence
  • ✓Laboratory studies supporting ongoing infection
  • ✓Imaging studies demonstrating hand bone infection
  • ✓Treatment history including antibiotic therapy
  • ✓Assessment of hand function and fine motor abilities
  • ✓Documentation of impact on activities of daily living

Commonly Confused Codes

  • •M86.641: Other chronic osteomyelitis, right hand (has laterality specified)
  • •M86.642: Other chronic osteomyelitis, left hand (has laterality specified)
  • •M86.549: Other chronic hematogenous osteomyelitis, unspecified hand (specifically hematogenous)
  • •M86.449: Chronic osteomyelitis with draining sinus, unspecified hand (has draining sinus)

Child Codes

M86.641Other chronic osteomyelitis, right hand
HCC 92
M86.642Other chronic osteomyelitis, left hand
HCC 92
M86.649Other chronic osteomyelitis, unspecified hand
HCC 92

Code Hierarchy

└M86Osteomyelitis└M86.6Other chronic osteomyelitis└M86.64Other chronic osteomyelitis, hand└M86.649Other chronic osteomyelitis, unspecified hand
└M86.649Other chronic osteomyelitis, unspecified hand

Because M86.649 maps to an HCC category, the documentation must satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) before the diagnosis is used for risk adjustment.

M86.649 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. The mapping identifies a payment HCC category for M86.649. Review its source-labeled HCC coefficient above, check the RAF Calculator with complete member context for CMS-HCC V28 PY2026, and confirm the documentation the chart needs before the code is submitted. HCC Buddy shows no RAF score unless every required source and calculation check passes.

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Open M86.649 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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