M87.238
BillableOsteonecrosis due to previous trauma of left carpus
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.238 an HCC code?
Yes. M87.238 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 M87.238
For M87.238 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 M87.238 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.238 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma of left carpus. Death of bone tissue in the wrist bones on the left side caused by a previous injury, resulting in bone deterioration and potential loss of function. M87.238 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, M87.238 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, M87.238 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.
Confirm documentation specifies left side to differentiate from right or unspecified codes. Because M87.238 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 M87.238 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm documentation specifies left side to differentiate from right or unspecified codes
- •Link to the original trauma documentation if available to support medical necessity
Clinical Significance
Left carpal osteonecrosis secondary to trauma represents a complex musculoskeletal condition requiring specialized orthopedic management and potentially impacting patient's dominant hand function. The condition often progresses without appropriate intervention and may necessitate advanced surgical procedures.
Documentation Requirements
- ✓Specific identification of left carpus involvement
- ✓Clear documentation of previous trauma to the left wrist
- ✓Radiological or clinical evidence of osteonecrosis in carpal bones
- ✓Functional assessment and impact on daily activities
- ✓Timeline from initial trauma to osteonecrosis diagnosis
- ✓Current pain levels and mobility restrictions
- ✓Any concurrent conditions or complications
- ✓Treatment history and patient response to interventions
Commonly Confused Codes
- •M87.237 — Osteonecrosis due to previous trauma of right carpus (wrong laterality)
- •M87.239 — Osteonecrosis due to previous trauma of unspecified carpus (when laterality is known)
- •M87.338 — Other secondary osteonecrosis of left carpus (non-traumatic secondary cause)
- •M87.242 — Osteonecrosis due to previous trauma, left hand (broader hand involvement)
- •M84.334A — Stress fracture, left radius (different bone and acute condition)