M87.250
BillableOsteonecrosis due to previous trauma, pelvis
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.250 an HCC code?
Yes. M87.250 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 M87.250
For M87.250 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 M87.250 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.250 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma, pelvis. Death of bone tissue in the pelvis caused by a previous injury, which can affect mobility and weight-bearing capacity. M87.250 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, M87.250 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, M87.250 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.
Pelvis is a single anatomical structure, so no laterality modifier is needed. Because M87.250 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 M87.250 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Pelvis is a single anatomical structure, so no laterality modifier is needed
- •Document the specific pelvic bone affected (ilium, pubis, ischium) in clinical notes for completeness
Clinical Significance
Pelvic osteonecrosis following trauma represents a severe complication affecting weight-bearing capacity and mobility. This condition often requires complex orthopedic management and may significantly impact patient's ability to ambulate independently, necessitating comprehensive rehabilitation and long-term monitoring.
Documentation Requirements
- ✓Clear identification of pelvic bone involvement
- ✓Documentation of previous trauma to pelvic area
- ✓Clinical or radiological evidence of bone necrosis in pelvic structures
- ✓Current weight-bearing status and mobility assessment
- ✓Pain levels and functional limitations
- ✓Any associated complications or secondary conditions
- ✓Treatment history and patient response
- ✓Impact on ambulation and activities of daily living
Commonly Confused Codes
- •M87.350 — Other secondary osteonecrosis, pelvis (non-traumatic secondary cause)
- •M87.051 — Idiopathic osteonecrosis of pelvis (when cause is unknown)
- •M84.359A — Stress fracture, pelvis (acute injury, not chronic osteonecrosis)
- •M87.9 — Osteonecrosis, unspecified (when pelvic involvement and trauma history are documented)
- •S32.9XXA — Fracture of unspecified parts of lumbosacral spine and pelvis (acute fracture)