M87.251
BillableOsteonecrosis due to previous trauma, right femur
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.251 an HCC code?
Yes. M87.251 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 M87.251
For M87.251 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 M87.251 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.251 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma, right femur. Death of bone tissue in the right thighbone (femur) caused by a previous injury or trauma to that area. M87.251 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, M87.251 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, M87.251 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.
Verify documentation specifies right femur and confirms osteonecrosis is due to previous trauma rather than other causes like idiopathic or radiation-related. Because M87.251 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 M87.251 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Verify documentation specifies right femur and confirms osteonecrosis is due to previous trauma rather than other causes like idiopathic or radiation-related
- •This code requires documentation of the causal relationship between the prior trauma and current osteonecrosis; review medical records for injury history
Clinical Significance
Right femoral osteonecrosis secondary to trauma represents a major weight-bearing bone complication that significantly impacts mobility and quality of life. This condition often progresses to femoral head collapse without appropriate intervention, potentially requiring total hip replacement and extensive rehabilitation.
Documentation Requirements
- ✓Specific identification of right femur involvement
- ✓Clear documentation of previous trauma to right hip/thigh area
- ✓Radiological evidence of femoral bone necrosis
- ✓Location within femur (head, neck, shaft) when specified
- ✓Current weight-bearing capacity and mobility status
- ✓Pain assessment and functional limitations
- ✓Risk factors for progression and complications
- ✓Treatment plan and surgical considerations