M86.672
BillableOther chronic osteomyelitis, left ankle and foot
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M86.672 an HCC code?
Yes. M86.672 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 M86.672
For M86.672 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 M86.672 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M86.672 is the ICD-10-CM diagnosis code for other chronic osteomyelitis, left ankle and foot. A chronic bone infection affecting the left ankle and foot bones that has persisted over time. M86.672 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, M86.672 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, M86.672 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.
Confirm the infection is on the left side before using this code; do not use for right-sided infections. Because M86.672 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 M86.672 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm the infection is on the left side before using this code; do not use for right-sided infections
- •Document any complications such as drainage, sinus tracts, or functional impairment related to the infection
Clinical Significance
Left ankle and foot chronic osteomyelitis represents a severe, persistent bone infection affecting complex weight-bearing structures essential for ambulation. This condition requires aggressive treatment approaches and carries significant risk for limb loss, chronic disability, and treatment-resistant infections due to limited vascular supply in distal extremities.
Documentation Requirements
- ✓Explicit chronic osteomyelitis diagnosis
- ✓Clear identification of left ankle and/or foot involvement
- ✓Documentation supporting chronic infection timeline
- ✓Radiological evidence of chronic bone changes
- ✓Microbiological data when cultures obtained
- ✓History of antibiotic treatment or surgical intervention
- ✓Functional assessment including ambulation status
- ✓Documentation of any associated vascular compromise