M87.119 ICD-10-CM Code: Osteonecrosis due to drugs, unspecified shoulder
HCC Buddy Code Card
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FY 2026 Apr update / Diseases of the musculoskeletal system and connective tissue (M00-M99) / Other osteopathies (M86-M90)
M87.119
Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidanceOsteonecrosis due to drugs, unspecified shoulder
Death of bone tissue in the shoulder caused by medication use, when the side is not specified.
Buddy Insight
Drug-induced osteonecrosis of unspecified shoulder indicates medication-related bone death when laterality is not documented, representing need for improved documentation specificity.
CMS-HCC V28
00
RAF 0
CMS-HCC V24
MappedHCC 39
RAF 0.482
ACA/HHS
00
RAF 0
ESRD/PACE
MappedHCC 39
RAF 0.0
RXHCC
MappedHCC 80
RAF 0.0
Code Trumping
Basket needed
Code Book Path
Inclusion Terms
OfficialICD-10-CM does not list inclusion terms for M87.119 in this effective period.
Excludes 2
OfficialICD-10-CM does not list Excludes 2 notes for M87.119 in this effective period.
Related Child Codes
Includes
OfficialICD-10-CM does not list Includes notes for M87.119 in this effective period.
Excludes 1
OfficialICD-10-CM does not list Excludes 1 notes for M87.119 in this effective period.
Code First
OfficialICD-10-CM does not list Code First sequencing instructions for M87.119 in this effective period.
Use Additional
OfficialICD-10-CM does not list Use Additional Code instructions for M87.119 in this effective period.
Code Also
OfficialICD-10-CM does not list Code Also instructions for M87.119 in this effective period.
Buddy Documentation Tip
MEAT Support
Audit Caution
Common Mistakes
Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.
Is M87.119 an HCC code?
Yes. M87.119 maps to Bone/Joint/Muscle Infections/Necrosis under the V24 model but is not retained in V28.
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 M87.119
For M87.119to 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 M87.119 during that encounter, not just copy-forwarded from a problem list.
What This Code Means
M87.119 is the ICD-10-CM diagnosis code for osteonecrosis due to drugs, unspecified shoulder. Death of bone tissue in the shoulder caused by medication use, when the side is not specified. M87.119 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 older CMS-HCC V24 model, M87.119 maps to Bone/Joint/Muscle Infections/Necrosis (HCC 39) with a community, non-dual, aged base RAF weight of 0.482. 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.
Use only when laterality cannot be determined from documentation. Because M87.119 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 M87.119 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when laterality cannot be determined from documentation
- •Query the provider if right or left shoulder can be determined
Clinical Significance
Drug-induced osteonecrosis of unspecified shoulder indicates medication-related bone death when laterality is not documented, representing need for improved documentation specificity. This condition requires immediate assessment of causative medications and potential therapy modifications to prevent progression and preserve shoulder function.
Documentation Requirements
- ✓Documentation of shoulder involvement without side specification
- ✓Clear identification of drug-induced etiology
- ✓Documentation of causative medication(s)
- ✓Imaging evidence of shoulder osteonecrosis
- ✓Temporal relationship between drug exposure and bone death
- ✓Functional assessment of shoulder
- ✓Evidence that laterality could not be determined
- ✓Medication review and modification planning
Commonly Confused Codes
- •M87.111 — Drug-induced osteonecrosis of right shoulder (use when laterality known)
- •M87.112 — Drug-induced osteonecrosis of left shoulder (use when laterality known)
- •M87.019 — Idiopathic osteonecrosis of unspecified shoulder (no drug cause)
- •M87.219 — Trauma-related osteonecrosis of unspecified shoulder (injury-related)
- •M87.319 — Other secondary osteonecrosis of unspecified shoulder (different cause)