M87.243
BillableOsteonecrosis due to previous trauma, unspecified hand
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.243 an HCC code?
Yes. M87.243 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 M87.243
For M87.243 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 M87.243 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.243 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma, unspecified hand. Death of bone tissue in the hand caused by a previous injury when the specific side (left or right) is not documented or specified. M87.243 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, M87.243 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, M87.243 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 is truly unspecified or cannot be determined. Because M87.243 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 M87.243 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use only when laterality is truly unspecified or cannot be determined
- •Attempt to clarify with provider documentation to assign more specific laterality code
Clinical Significance
Unspecified hand osteonecrosis following trauma indicates significant bone pathology requiring ongoing specialized care and monitoring. This condition suggests complex bone healing complications that may necessitate advanced surgical interventions and comprehensive rehabilitation.
Documentation Requirements
- ✓Documentation of hand involvement without specified laterality
- ✓Clear evidence of previous trauma to hand area
- ✓Clinical or radiological confirmation of bone necrosis
- ✓Justification for unspecified laterality (bilateral involvement or unclear documentation)
- ✓Current functional assessment and limitations
- ✓Pain levels and impact on daily activities
- ✓Treatment history and effectiveness
- ✓Any associated complications or secondary conditions
Commonly Confused Codes
- •M87.241 — Osteonecrosis due to previous trauma, right hand (when laterality is documented)
- •M87.242 — Osteonecrosis due to previous trauma, left hand (when laterality is documented)
- •M87.246 — Osteonecrosis due to previous trauma, unspecified finger(s) (more specific involvement)
- •M87.343 — Other secondary osteonecrosis, unspecified hand (non-traumatic cause)
- •M87.239 — Osteonecrosis due to previous trauma of unspecified carpus (carpal-specific)