M87.011
BillableIdiopathic aseptic necrosis of right shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.011 an HCC code?
Yes. M87.011 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 M87.011
For M87.011 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 M87.011 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.011 is the ICD-10-CM diagnosis code for idiopathic aseptic necrosis of right shoulder. Death of bone tissue without infection in the right shoulder joint, occurring without a known cause. M87.011 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, M87.011 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, M87.011 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.
Ensure documentation specifies 'right' shoulder to distinguish from left or unspecified. Because M87.011 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 M87.011 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure documentation specifies 'right' shoulder to distinguish from left or unspecified
- •Consider if this is related to prior trauma or corticosteroid use, which would indicate a different code
Clinical Significance
Idiopathic aseptic necrosis of the right shoulder represents a serious condition affecting the humeral head, often requiring surgical intervention such as joint replacement. This anatomically specific diagnosis indicates significant functional impairment and chronic pain affecting the patient's dominant or non-dominant arm function.
Documentation Requirements
- ✓Documentation of aseptic necrosis specifically affecting right shoulder
- ✓Confirmation of idiopathic etiology (no identifiable cause)
- ✓Imaging studies showing necrosis of humeral head or shoulder bones
- ✓Laterality clearly documented as right side
- ✓Exclusion of infectious causes
- ✓Functional assessment of shoulder range of motion
- ✓Treatment plan including physical therapy or surgical options
- ✓Pain level documentation and impact on activities of daily living