M87.256
BillableOsteonecrosis due to previous trauma, unspecified femur
Last updated: FY2026 ICD-10-CM (Oct 1, 2025 – Sep 30, 2026) | CMS-HCC V28 (100% phase-in, PY2026)
Is M87.256 an HCC code?
Yes. M87.256 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 M87.256
For M87.256 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 M87.256 during that encounter — not just copy-forwarded from a problem list.
What This Code Means
M87.256 is the ICD-10-CM diagnosis code for osteonecrosis due to previous trauma, unspecified femur. Death of bone tissue in the thighbone (femur) caused by previous trauma, but the specific side (left or right) is not specified or documented. M87.256 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, M87.256 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, M87.256 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 this code only when laterality cannot be determined from documentation; query provider if possible to obtain specific side information. Because M87.256 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 M87.256 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.
Coding Tips
- •Use this code only when laterality cannot be determined from documentation; query provider if possible to obtain specific side information
- •This is a less specific code; attempt to clarify whether the condition affects the right or left femur for more accurate coding
Clinical Significance
Unspecified femoral osteonecrosis following trauma indicates major bone pathology affecting primary weight-bearing function with significant implications for mobility and independence. This condition typically requires advanced orthopedic intervention and comprehensive rehabilitation planning.
Documentation Requirements
- ✓Documentation of femur involvement without specified laterality
- ✓Clear history of previous trauma to hip/thigh area
- ✓Evidence of osteonecrosis in femoral bone structures
- ✓Justification for unspecified laterality (bilateral involvement or unclear documentation)
- ✓Current mobility status and weight-bearing capacity
- ✓Functional assessment and pain evaluation
- ✓Treatment planning and surgical considerations
- ✓Impact on patient independence and daily functioning