M86.8X4
BillableOther osteomyelitis, hand
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M86.8X4 an HCC code?
Yes. M86.8X4 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 M86.8X4
For M86.8X4 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 M86.8X4 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M86.8X4 is the ICD-10-CM diagnosis code for other osteomyelitis, hand. A bone infection (osteomyelitis) affecting the hand bones that doesn't fit into other specific osteomyelitis categories. M86.8X4 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, M86.8X4 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, M86.8X4 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.
This code covers osteomyelitis of carpal bones, metacarpals, and phalanges. Because M86.8X4 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 M86.8X4 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •This code covers osteomyelitis of carpal bones, metacarpals, and phalanges
- •Verify the infection type is not acute or chronic before using this 'other' classification
Clinical Significance
Other osteomyelitis of the hand represents bone infection in the complex small bones of the hand that doesn't fit standard acute or chronic criteria. This condition poses significant risk to fine motor function and dexterity, requiring specialized hand surgery consultation and aggressive treatment to prevent permanent functional impairment and preserve hand anatomy.
Documentation Requirements
- ✓Clear documentation of hand bone osteomyelitis
- ✓Rationale for 'other' classification versus acute or chronic
- ✓Specification of which hand bones are affected
- ✓Detailed imaging studies showing bone involvement
- ✓Culture or biopsy results when obtained
- ✓Specialized hand therapy or surgical consultation
- ✓Assessment of hand function and dexterity
- ✓Documentation of unique clinical characteristics