M87.229
BillableOsteonecrosis due to previous trauma, unspecified humerus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.229 an HCC code?
Yes. M87.229 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 M87.229
For M87.229 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 M87.229 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.229 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma, unspecified humerus. Death of bone tissue in the upper arm bone (humerus) due to previous trauma when the specific side is not identified. M87.229 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, M87.229 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, M87.229 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 only when laterality cannot be determined from the medical record. Because M87.229 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 M87.229 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 the medical record
- •Query the provider if documentation is unclear about which arm is affected
Clinical Significance
Osteonecrosis due to previous trauma represents a serious complication following bone injury, indicating compromised blood supply leading to bone death. This condition significantly impacts patient mobility and may require surgical intervention including bone grafting or joint replacement.
Documentation Requirements
- ✓Documentation of previous trauma or injury to the humerus
- ✓Evidence of bone necrosis through imaging (X-ray, MRI, or bone scan)
- ✓Clinical symptoms such as pain, limited range of motion, or functional impairment
- ✓Exclusion of other causes of osteonecrosis (steroids, alcohol, radiation)
- ✓Confirmation that laterality is unknown or not documented
- ✓Provider assessment linking current osteonecrosis to previous trauma
- ✓Timeline establishing temporal relationship between trauma and necrosis
- ✓Physical examination findings consistent with osteonecrosis