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M87.012 ICD-10-CM Code: Idiopathic aseptic necrosis of left shoulder

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

M87.012

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

Idiopathic aseptic necrosis of left shoulder

Death of bone tissue without infection in the left shoulder joint, occurring without a known cause.

Buddy the Bee presenting code insight

Buddy Insight

Idiopathic aseptic necrosis of the left shoulder involves bone death in the humeral head without known cause, typically requiring extensive orthopedic management and potential joint replacement.

CMS-HCC V28

HCC 92

RAF 0.479

CMS-HCC V24

HCC 39

RAF 0.401

ACA/HHS

HCC 55

Varies by metal level

ESRD/PACE

HCC 39

RAF 0.092

RXHCC

HCC 80

RAF 0.204

Code Book Path

Official
M87.0Idiopathic aseptic necrosis of bone
M87.01Idiopathic aseptic necrosis of shoulder
M87.012Idiopathic aseptic necrosis of left shoulder

Inclusion Terms

Official
  • Idiopathic aseptic necrosis of clavicle and scapula

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M87.012 in this effective period.

Related Child Codes

Official
M87.011Idiopathic aseptic necrosis of right shoulder
M87.019Idiopathic aseptic necrosis of unspecified shoulder

Includes

Official

ICD-10-CM does not list Includes notes for M87.012 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M87.012 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M87.012 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M87.012 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M87.012 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Clear documentation of aseptic necrosis involving left shoulder
Confirmation of idiopathic nature (no identifiable underlying cause)
Imaging evidence demonstrating bone necrosis in left shoulder structures
Specific laterality documentation identifying left side involvement

MEAT Support

HCC Buddy guidance
Clear documentation of aseptic necrosis involving left shoulder
Confirmation of idiopathic nature (no identifiable underlying cause)
Imaging evidence demonstrating bone necrosis in left shoulder structures
Specific laterality documentation identifying left side involvement

Audit Caution

HCC Buddy guidance
Reversing laterality when documentation clearly states left shoulder
Defaulting to unspecified codes when laterality is documented
Missing medication history that would indicate drug-induced etiology
Overlooking trauma history requiring different code classification

Common Mistakes

HCC Buddy guidance
M87.011 — Right shoulder when laterality is incorrectly assigned
M87.019 — Unspecified shoulder when left side is clearly documented
M87.112 — Drug-induced left shoulder osteonecrosis
M87.212 — Trauma-related left shoulder osteonecrosis

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 M87.012 an HCC code?

Yes. M87.012 (Idiopathic aseptic necrosis of left shoulder) maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis under the CMS-HCC V28 risk adjustment model (and Bone/Joint/Muscle Infections/Necrosis under V24), with a community non-dual aged RAF of 0.479. It is billable for payment year 2026.

Coder answer: M87.012 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
M87.012
Description
Idiopathic aseptic necrosis of left shoulder
HCC (V28)
HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
RAF
0.479
Billable
Yes
Payment year
2026

HCC Category Mapping

V28HCC 92, Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
0.479
V24HCC 39, Bone/Joint/Muscle Infections/Necrosis
0.401
ESRDHCC 39, Bone/Joint/Muscle Infections/Necrosis
0.092
RxHCCHCC 80, Bone/Joint/Muscle Infections/Necrosis
0.204

Each model's RAF is its CMS base weight for that model's standard population, so 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 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.

Work M87.012 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for M87.012

For M87.012 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 M87.012 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

M87.012 is the ICD-10-CM diagnosis code for idiopathic aseptic necrosis of left shoulder. Death of bone tissue without infection in the left shoulder joint, occurring without a known cause. M87.012 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, M87.012 maps to Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis (HCC 92) with a community, non-dual, aged base RAF weight of 0.479. Under the older CMS-HCC V24 model, M87.012 maps to Bone/Joint/Muscle Infections/Necrosis (HCC 39) with a community, non-dual, aged base RAF weight of 0.401. 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 laterality is documented as 'left' in the medical record. Because M87.012 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 M87.012 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •Confirm laterality is documented as 'left' in the medical record
  • •This code is specific to the left side; do not use if the side is unspecified or bilateral

Clinical Significance

Idiopathic aseptic necrosis of the left shoulder involves bone death in the humeral head without known cause, typically requiring extensive orthopedic management and potential joint replacement. This condition severely impacts shoulder function and often results in chronic pain and disability affecting work and daily activities.

Documentation Requirements

  • ✓Clear documentation of aseptic necrosis involving left shoulder
  • ✓Confirmation of idiopathic nature (no identifiable underlying cause)
  • ✓Imaging evidence demonstrating bone necrosis in left shoulder structures
  • ✓Specific laterality documentation identifying left side involvement
  • ✓Exclusion of infectious etiology through clinical assessment
  • ✓Range of motion limitations and functional impairment documentation
  • ✓Treatment approach including conservative vs surgical management
  • ✓Pain assessment and impact on patient's quality of life

Commonly Confused Codes

  • •M87.011: Right shoulder when laterality is incorrectly assigned
  • •M87.019: Unspecified shoulder when left side is clearly documented
  • •M87.112: Drug-induced left shoulder osteonecrosis
  • •M87.212: Trauma-related left shoulder osteonecrosis
  • •M25.512: Left shoulder pain without bone necrosis

Child Codes

M87.011Idiopathic aseptic necrosis of right shoulder
HCC 92
M87.012Idiopathic aseptic necrosis of left shoulder
HCC 92
M87.019Idiopathic aseptic necrosis of unspecified shoulder
HCC 92

Code Hierarchy

└M87Osteonecrosis└M87.0Idiopathic aseptic necrosis of bone└M87.01Idiopathic aseptic necrosis of shoulder└M87.012Idiopathic aseptic necrosis of left shoulder
└M87.012Idiopathic aseptic necrosis of left shoulder

Because M87.012 maps to a payment HCC, the documentation must also satisfy MEAT criteria (Monitor, Evaluate, Assess, or Treat) for the encounter to count toward the patient's risk adjustment score.

M87.012 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. Because M87.012 carries a payment HCC, you can see what it adds to a RAF score and check the documentation the chart needs before it is submitted.

Work M87.012 in HCC Buddy

Open M87.012 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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