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M87.221 ICD-10-CM Code: Osteonecrosis due to previous trauma, right humerus

M87.221 maps to CMS-HCC V28 92 (RAF 0.479). Documentation must support MEAT. MEAT criteria · RAF calculator · free HCC coding tools

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

M87.221

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

Osteonecrosis due to previous trauma, right humerus

Death of bone tissue in the right upper arm bone (humerus) resulting from a previous injury.

Buddy the Bee presenting code insight

Buddy Insight

Trauma-related osteonecrosis of the right humerus represents bone death in the upper arm bone resulting from previous injury, requiring specialized orthopedic management to preserve arm function.

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
M87.2Osteonecrosis due to previous trauma
M87.22Osteonecrosis due to previous trauma, humerus
M87.221Osteonecrosis due to previous trauma, right humerus

Inclusion Terms

Official

ICD-10-CM does not list inclusion terms for M87.221 in this effective period.

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for M87.221 in this effective period.

Related Child Codes

Official
M87.222Osteonecrosis due to previous trauma, left humerus
M87.229Osteonecrosis due to previous trauma, unspecified humerus

Includes

Official

ICD-10-CM does not list Includes notes for M87.221 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for M87.221 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for M87.221 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for M87.221 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for M87.221 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance
Specific documentation of right humerus involvement
Clear history of previous trauma or injury to arm
Imaging studies confirming humeral osteonecrosis
Timeline establishing relationship between trauma and bone death

MEAT Support

HCC Buddy guidance
Specific documentation of right humerus involvement
Clear history of previous trauma or injury to arm
Imaging studies confirming humeral osteonecrosis
Timeline establishing relationship between trauma and bone death

Audit Caution

HCC Buddy guidance
Failing to confirm right humerus specificity in documentation
Not establishing trauma-related etiology with clear injury history
Missing temporal connection between trauma and osteonecrosis development
Confusing with acute fractures or other humeral pathology

Common Mistakes

HCC Buddy guidance
M87.021 — Idiopathic osteonecrosis of right humerus (no trauma cause)
M87.121 — Drug-induced osteonecrosis of right humerus (medication-related)
M87.321 — Other secondary osteonecrosis of right humerus (different secondary cause)
M87.222 — Trauma-related osteonecrosis of left humerus (wrong laterality)

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 M87.221 an HCC code?

Yes. M87.221 (Osteonecrosis due to previous trauma, right humerus) 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: M87.221 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
M87.221
Description
Osteonecrosis due to previous trauma, right humerus
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 M87.221 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for M87.221

For M87.221 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 M87.221 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

M87.221 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma, right humerus. Death of bone tissue in the right upper arm bone (humerus) resulting from a previous injury. M87.221 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, M87.221 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, M87.221 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.

This code specifies the right side; ensure documentation clearly indicates right humerus involvement. Because M87.221 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 M87.221 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

  • •This code specifies the right side; ensure documentation clearly indicates right humerus involvement
  • •Link this diagnosis to the original traumatic injury when possible for complete clinical documentation

Clinical Significance

Trauma-related osteonecrosis of the right humerus represents bone death in the upper arm bone resulting from previous injury, requiring specialized orthopedic management to preserve arm function. This serious condition can significantly impact strength and mobility, potentially progressing to fracture or joint complications without appropriate treatment.

Documentation Requirements

  • ✓Specific documentation of right humerus involvement
  • ✓Clear history of previous trauma or injury to arm
  • ✓Imaging studies confirming humeral osteonecrosis
  • ✓Timeline establishing relationship between trauma and bone death
  • ✓Assessment of right arm function and strength
  • ✓Documentation of original injury mechanism and severity
  • ✓Treatment response monitoring
  • ✓Evaluation for potential surgical intervention

Commonly Confused Codes

  • •M87.021: Idiopathic osteonecrosis of right humerus (no trauma cause)
  • •M87.121: Drug-induced osteonecrosis of right humerus (medication-related)
  • •M87.321: Other secondary osteonecrosis of right humerus (different secondary cause)
  • •M87.222: Trauma-related osteonecrosis of left humerus (wrong laterality)
  • •S42.201: Unspecified fracture of right humerus (acute injury, not necrosis)

Child Codes

M87.221Osteonecrosis due to previous trauma, right humerus
HCC 92
M87.222Osteonecrosis due to previous trauma, left humerus
HCC 92
M87.229Osteonecrosis due to previous trauma, unspecified humerus
HCC 92

Code Hierarchy

└M87Osteonecrosis└M87.2Osteonecrosis due to previous trauma└M87.22Osteonecrosis due to previous trauma, humerus└M87.221Osteonecrosis due to previous trauma, right humerus
└M87.221Osteonecrosis due to previous trauma, right humerus

Because M87.221 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.

M87.221 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 M87.221 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 M87.221 in HCC Buddy

Open M87.221 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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