M87.252
BillableOsteonecrosis due to previous trauma, left femur
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.252 an HCC code?
Yes. M87.252 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 M87.252
For M87.252 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 M87.252 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.252 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma, left femur. Death of bone tissue in the left thighbone (femur) caused by a previous injury or trauma to that area. M87.252 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, M87.252 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, M87.252 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 laterality is documented as left femur in the clinical record before assigning this code. Because M87.252 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 M87.252 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Confirm laterality is documented as left femur in the clinical record before assigning this code
- •Document the timeline between the original trauma and diagnosis of osteonecrosis to support medical necessity
Clinical Significance
Left femoral osteonecrosis following trauma is a serious complication affecting the major weight-bearing bone, potentially leading to significant disability and need for joint replacement. This condition requires specialized orthopedic management and may significantly impact patient mobility and independence.
Documentation Requirements
- ✓Clear identification of left femur involvement
- ✓Documentation of previous trauma to left hip/thigh area
- ✓Imaging confirmation of osteonecrosis in femoral bone
- ✓Anatomical location within femur (head, neck, shaft) if specified
- ✓Assessment of weight-bearing ability and ambulation status
- ✓Current pain levels and functional capacity
- ✓Treatment history and surgical planning
- ✓Impact on patient mobility and quality of life
Commonly Confused Codes
- •M87.251 — Osteonecrosis due to previous trauma, right femur (wrong laterality)
- •M87.256 — Osteonecrosis due to previous trauma, unspecified femur (when laterality is known)
- •M87.352 — Other secondary osteonecrosis, left femur (non-traumatic secondary cause)
- •M87.052 — Idiopathic osteonecrosis of left femur (unknown etiology)
- •M84.359A — Stress fracture, hip (acute injury versus chronic necrosis)