M87.211
BillableOsteonecrosis due to previous trauma, right shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.211 an HCC code?
Yes. M87.211 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 M87.211
For M87.211 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 M87.211 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.211 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma, right shoulder. Bone death in the right shoulder resulting from a previous injury or trauma. M87.211 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, M87.211 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, M87.211 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.
Document the original traumatic event and the time interval between injury and osteonecrosis development. Because M87.211 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 M87.211 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Document the original traumatic event and the time interval between injury and osteonecrosis development
- •Specify which shoulder bone is affected (humerus, scapula) if documented for additional clarity
Clinical Significance
Trauma-related osteonecrosis of the right shoulder represents bone death resulting from previous injury, requiring ongoing orthopedic evaluation and management to preserve shoulder function. This condition can significantly impact upper extremity mobility and strength, potentially requiring surgical intervention if conservative management fails.
Documentation Requirements
- ✓Specific documentation of right shoulder involvement
- ✓Clear history of previous trauma or injury to shoulder
- ✓Imaging studies confirming shoulder osteonecrosis
- ✓Timeline relationship between trauma and bone death development
- ✓Assessment of right shoulder function and range of motion
- ✓Documentation of mechanism of original injury
- ✓Treatment response and progression monitoring
- ✓Consideration for surgical intervention if indicated