M87.078 ICD-10-CM Code: Idiopathic aseptic necrosis of left toe(s)
M87.078 maps to CMS-HCC V28 92 (RAF 0.479). 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)
M87.078
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceIdiopathic aseptic necrosis of left toe(s)
Death of bone tissue in the left toe(s) without infection, occurring without a known cause.
Buddy Insight
Idiopathic aseptic necrosis of left toe(s) indicates bone death in the digits without infection or known etiology, requiring ongoing orthopedic evaluation and management to prevent progression and functional impairment.
CMS-HCC V28
MappedHCC 92
RAF 0.479
CMS-HCC V24
MappedHCC 39
RAF 0.401
ACA/HHS
MappedHCC 55
Varies by metal level
ESRD/PACE
MappedHCC 39
RAF 0.092
RXHCC
MappedHCC 80
RAF 0.204
Code Book Path
Inclusion Terms
Official- Idiopathic aseptic necrosis of metatarsus, tarsus, and phalanges of toes
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M87.078 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M87.078 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M87.078 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M87.078 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M87.078 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M87.078 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
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 M87.078 an HCC code?
Yes. M87.078 (Idiopathic aseptic necrosis of left toe(s)) 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: M87.078 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
- M87.078
- Description
- Idiopathic aseptic necrosis of left toe(s)
- HCC (V28)
- HCC 92 — Bone/Joint/Muscle/Severe Soft Tissue Infections/Necrosis
- RAF
- 0.479
- Billable
- Yes
- Payment year
- 2026
HCC Category Mapping
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 M87.078 in the Code Book — tabular path, V28 RAF, and MEAT checklist →
MEAT Criteria for M87.078
For M87.078 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 M87.078 during that encounter, not just copy-forwarded from a problem list.
Coder workflow notes
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What This Code Means
M87.078 is the ICD-10-CM diagnosis code for idiopathic aseptic necrosis of left toe(s). Death of bone tissue in the left toe(s) without infection, occurring without a known cause. M87.078 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, M87.078 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, M87.078 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.
Ensure left-sided toe involvement is clearly documented in the medical record. Because M87.078 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 M87.078 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Ensure left-sided toe involvement is clearly documented in the medical record
- •This code encompasses all left toes; specify individual toe involvement in clinical documentation if relevant
Clinical Significance
Idiopathic aseptic necrosis of left toe(s) indicates bone death in the digits without infection or known etiology, requiring ongoing orthopedic evaluation and management to prevent progression and functional impairment. This condition can significantly impact weight-bearing activities and may require surgical intervention if conservative treatment fails.
Documentation Requirements
- ✓Specific documentation of left toe(s) involvement
- ✓Confirmation that no infection is present (aseptic)
- ✓Documentation that cause is idiopathic/unknown
- ✓Imaging evidence supporting bone necrosis diagnosis
- ✓Clinical examination findings consistent with osteonecrosis
- ✓Exclusion of secondary causes (drugs, trauma, other conditions)
- ✓Functional impact assessment on mobility
- ✓Treatment response documentation
Commonly Confused Codes
- •M87.178: Drug-induced osteonecrosis of left toe(s) (requires medication etiology)
- •M87.278: Trauma-related osteonecrosis of left toe(s) (requires injury history)
- •M87.077: Right toe(s) osteonecrosis (incorrect laterality)
- •M86.172: Chronic osteomyelitis of left toe (infectious condition)
- •T79.3: Post-traumatic wound infection (different pathology)