M87.219
BillableOsteonecrosis due to previous trauma, unspecified shoulder
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.219 an HCC code?
Yes. M87.219 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 M87.219
For M87.219 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 M87.219 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.219 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma, unspecified shoulder. Death of bone tissue in the shoulder due to a previous injury, when the specific shoulder is not specified. M87.219 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, M87.219 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, M87.219 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.
Use this code only when the shoulder location is unspecified; if laterality is known, use M87.211 (right) or M87.212 (left). Because M87.219 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 M87.219 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
Clinical Significance
Trauma-related osteonecrosis of unspecified shoulder represents bone death from previous injury when laterality is not documented, indicating need for improved documentation specificity. This condition requires ongoing orthopedic evaluation and may necessitate surgical intervention to preserve shoulder function and prevent disability.
Documentation Requirements
- ✓Documentation of shoulder involvement without laterality specification
- ✓Clear history of previous trauma or injury
- ✓Imaging evidence of shoulder osteonecrosis
- ✓Timeline relationship between trauma and bone death
- ✓Functional assessment of shoulder
- ✓Evidence that laterality could not be determined
- ✓Treatment planning documentation
- ✓Monitoring for progression or complications